Transplantation versus coronary artery bypass in patients with severe ventricular dysfunction. Surgical outcome and quality of life

Background. The purpose of this study is to evaluate the quality of life, f unctional status and survival rate of patients with left ventricular electi on fraction (LVEF) less than or equal to 20% following coronary bypass (CAB G) versus heart transplantation. Methods. Experimental design: comparative study, mean follow-up of 20 month s. Setting: division of cardiac surgery at a McGill University-based hospit al in Montreal, Canada. Patients: the charts of 65 consecutive patients wit h angiographic LVEF less than or equal to 20% were reviewed. Among these pa tients, 14/65 were referred for transplantation but instead underwent CABG (Group I) after consultation with the transplant committee. The charts of 1 4 matched transplant patients (Group II) were reviewed. The SF-36 and Duke' s questionnaire forms were mailed to both groups in order to evaluate their quality of life and functional capacity, respectively. Interventions: comp arison between coronary bypass and heart transplantation. Measures: main outcome measures were mortality, quality of life, and functi onal capacity. Results. Results are expressed as mean+/-SEM. The in-hospital mortality rat e of CABG among all patients with LVEF less than or equal to 20% was 4.6% ( 3/65), Among the 14 CABG patients initially referred for transplantation, p erioperative mortality was 1/14 (7.1%), same as In the matched transplant g roup. Three additional group I patients were reported by family to have die d of cardiac events at follow-up period. Postoperative death identified at follow-up was assigned the lowest life quality score. The transformed quali ty of Life scores were as follows: physical functioning: I=42.5+/-10.6, II= 73.2+/-7.2, p=0.029; physical role: I=35.0+/- 13.5, II=61.4+/-13.2, p=0.180 ; bodily pain: I-54.0+/-14.0, II=69.8+/-8.5, p=0.349; general health: I=34. 7+/-9.2, II=84.6 +/-5.2, p=0.0003; vitality: I=36.5+/-9.3, II=60.0+/-5.2, p =0.045; social functioning: I=55.0+/-4.0, II=87.5+/-5.1, p=0.050; emotional Role: I=36.7+/-15.3, II=87.9+/-6.8, p=0.009; mental health: I=52.8+/-12.4, II=81.5+/-4.2, p=0.054. Duke's activity status index: I=16.8+/-4.2, II=31. 8+/-4.2, p=0.021. Conclusions. Heart transplant is associated with a significantly superior p ostoperative quality of life and functional capacity than bypass surgery. H owever, in patients with LVEF less than or equal to 20%, CABG can be perfor med with an acceptable perioperative mortality of 4.6%-7.1%, similar to the rate for transplantation.