Revascularization in patients with severe left ventricular impairment who have ischemic heart disease

OBJECTIVE: To assess the effect of coronary bypass grafting on left ventricular (LV) function, exercise capacity and symptom profile in patients with LV impairment and retrospectively evaluate the role of the different factors affecting LV.

METHODS: A total of 45 patients (33 men, 12 women, mean age 63.49 ± 7.38 years) with LV ejection fraction of less than 0.32 were admitted to the Istanbul University, Cardiology Institute, Istanbul, Turkey between January 2001 to June 2003 for coronary bypass operation. Preoperative and postoperative wall motion, functional class (New York Heart Association) and risk factors were analyzed.

RESULTS: We had one perioperative mortality (2.2%) and 2 early postoperative mortality (4.4%) due to poor cardiac function. There was a significant increase in the mean LV ejection fraction from 26.64 ± 5.17 to 32.98 ± 6.38 (p<0.001) postoperatively. In this group the mean New York Heart Association grade improved from 2.07 ± 0.76 to 1.5 ± 0.79 (p<0.001). Preoperative functional class, congestive heart failure, arrhythmia, age, pre/postoperative complications were the main predictors of poor outcome following surgical revascularization for ischemic cardiomyopathy.

CONCLUSION: In patients with severe LV impairment with myocardial hibernation, coronary artery bypass grafting improves both global and regional LV function and symptom profile. We therefore, recommend a coronary artery bypass grafting as an alternative to orthotopic heart transplantation whenever myocardial viability are documented.