Long-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium

Objective: Long-term left ventricular (LV) performance and patient outcome after coronary artery bypass grafting (CABG) procedure in the presence of d epressed LV function and hibernating myocardium (HM) have been poorly deter mined. Therefore, we prospectively evaluated patients undergoing CABG with severe LV dysfunction and HM to elucidate postoperative prognosis. Methods: We enrolled 120 consecutive patients undergoing CABG with severe LV dysfun ction and RM as assessed by dobutamine echocardiography and by rest-redistr ibution radionuclide (Thallium-201) study. Mean patient age was 60 +/- 9 ye ars (range 31-77 years). Mean preoperative LVEF was 28% +/- 9 (range 10-40% ). All patients underwent echocardiographic study to assess LV recovery of function intraoperatively, prior to hospital discharge, at 3 months, at I y ear, and yearly during the follow-up. Univariate and multivariate analysis were performed to to evaluate predictors of postoperative survival. Results : There were 2 hospital (1.6%) and 15 late (12.5%) deaths, mainly for heart failure, leading to an actuarial survival of 80 +/- 6% and 60 +/- 9% at 5 and 8 years, respectively. LVEF significantly improved perioperatively (fro m 28 +/- 9% to 40 +/- 2%, P < 0.01). Increase in LVEF, however, was gradual ly offset over the time (EF of 33 +/- 9%, 32 +/- 8%, and 30 +/- 9% at 3 mon ths, and 12 months, and 8 years after surgery, respectively). Furthermore, patients who experienced limited LV functional recovery perioperatively had a more remarkable decline of LVEF thereafter, and suffered from recurrence of heart failure symptoms (freedom from heart failure 82 +/- 5% and 60 +/- 8% at 4 and 8 years respectively). Advanced preoperative NYHA Class, and a ge were independent risks factors for reduced postoperative survival. Preop erative angina and use of arterial conduits apparently did not influence pa tient morbidity and mortality at long term. Conclusion: CABG procedure in t he presence of HM enhances LV recovery of function and has a favourable, pr ognosis. Functional benefit of the left ventricle, however, appears to be t ime-limited, despite remarkable improvement in patient functional capacity. Advanced preoperative heart failure, minimal perioperative improvement of LVEF, and a.-e account for a poor long-term prognosis. (C) 2001 Elsevier Sc ience B.V. All rights reserved.