Results of revascularization in patients with severe left ventricular dysfunction

Objective: In patients with coronary disease and poor left ventricular func tion, bypass grafting remains a surgical challenge, This study evaluates ex perience in 125 consecutive patients with ejection fraction less than 20% ( study group). Methods: Preoperative viability studies were not used for pat ient selection. Clinical data were prospectively collected, The average age of the study subjects was 59 +/- 9 years, and 112 (90%) were male. Most pa tients (108 [86%]) were in symptom class III or IV, Main indications for su rgery included angina in 62 (50%), heart failure and angina in 36 (29%), he art failure in 9 (7%), ventricular arrhythmia in 2 (2%), and critical anato my in 16 (13%). Significant mitral regurgitation was present in 48 (38%), a nd distal vessels were poorly visualized in 67 (54%). At surgery, temperatu re mapping guided an integrated approach to cold cardioplegia, Results in t his group were compared with those obtained in case-matched control subject s receiving cardioplegia without temperature mapping (matched For age, sex, functional class, and urgency of operation). Results: Hospital morbidity ( intra-aortic balloon pump support) and mortality rates mere significantly l ower in the study group versus those of control subjects (15% vs 30%, P =.0 04; and 4% vs 11%, P =.03, respectively). In study patients the 5-year actu arial survival was 72%. Among survivors, both anginal class and heart failu re class improved significantly, By means of multivariate analysis, surviva l was adversely affected by older age, class IV symptoms, and poorly visual ized distal vessels. Conclusions: These results support the use of coronary artery bypass grafting in patients with severe left ventricular dysfunctio n without case selection on the basis of viability studies or visibility of distal vessels, Low hospital morbidity and mortality rates have been achie ved when temperature mapping guides cardioplegia, Symptoms are improved in most patients, and long-term survival is encouraging.