EFFECTIVENESS OF SURGICAL REVASCULARIZATION IN LEFT VENTRICULAR

Fatih İSLAMOĞLU, Tanzer ÇALKAVUR, Hasan REYHANOĞLU, Fatih AYIK, Münevver YÜKSEL, Ahmet HAMULU, Suat BÜKET, İsa DURMAZ

Ege Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Anabilim Dalı, İZMİR

Background: Coronary artery bypass grafting (CABG) in patients with poor left ventricular function remains a surgical challenge and an arguable matter. Purposes of this study were to evaluate the effectiveness of CABG in such patients and to determine the risk factors affecting mortality and morbidity.

Methods: The preoperative, perioperative, and postoperative early and mid-term follow-up data of 121 patients with < 30% left ventricular ejection fraction (LVEF), who underwent CABG in the Cardiovascular Surgery Department of Ege University between 1997 and 1999, were evaluated. No preoperative viability study was performed for patient selection. Follow-up data after the discharge of these patients were obtained via monthly periodical examinations in the first 6 months, and thereafter via telephone interviews. As preoperatively, 109 (90.09%) patients were in NYHA class III or IV, 59 (48.76%) patients were in digoksin management for low LWEF, and the mean LVEF was 27.34% ± 3.12%.

Results: The overall hospital mortality was 7 (5.78%) patients. There were 2 (1.65%) late mortalities. Postoperative morbidities were observed in 30 (24.79%) patients. One-hundred and five (93.75%) of surviving 112 (92.56%) patients were in NYHA class I or II in 22 ± 10.24 months of follow-up. Patients in digoksin management lowered significantly to 32 (27.5%). Postoperative follow-up echocardiographic examination of 48 patients revealed 39.83% ± 5.21% of the mean LVEF. The improvements in functional capacity and LVEF were significant. Preoperative risk factors associated with increased early mortality and morbidity were older age, diabetes, hypertension, poor anginal and functional class.

Conclusions: The low mortality and morbidity rates as well as satisfactory postoperative improvements in functional capacity and LVEF measurements support the use of CABG without any need of any viability assessment, in patients with left ventricular dysfunction.

Keywords : Coronary artery bypass, left ventricular dysfunction, low ejection fraction, revascularization

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