To evaluate in a cohort of end-stage coronary artery disease (ESCAD) patients: 1) the effects of coronary artery bypass grafting (CABG) on left ventricular function, operative and mid-term survival; 2) the perioperative benefits of beating heart CABG procedure; 3) the variables predicting poor postoperative ouctome. Methods: Between January 1992 and May 1999, 218 ESCAD patients underwent CABG. Mean age was 65.7 ± 4.5 (range 59-77), males 146. NYHA and CCS class were 3.2 ± 1.0 and 3.4 ± 0.7 respectively. 72 (33%) patients had PTCA preoperatively, 139 (64%) patients presented triple vessel disease. LVEF (%) 26.2 ± 6, LVEDP (mmHg) 27.9 ± 6.8 and LVEDD (mm) 69.4 ± 5.7. 46/218 (21%) patients underwent beating heart CABG procedure. At 1 year after CABG, 183 from 188 survivors underwent TI201 scintigraphy. Results: The postoperative mortality was 20 (9%) patients. The LVEDP and LVEDD improved significantly after CABG (p = 0.003 and p = 0.008). LVEF and MVI in surviving patients were significantly higher versus failed CABG (p = 0.009 and p = 0.033). LVEDP and LVEDD were significantly lower in surviving patients (p = 0.011 and p = 0.008). Postoperative low cardiac output, bleeding and renal complications were significantly higher in ESCAD patients undergoing conventional versus beating heart CABG (p = 0.039, p = 0.029 and p = 0.027). At 1 year after the CABG, the LVEF increased signficantly versus immediate postoperative data (p < 0.004). The actuarial survival at 1, 3 and 5 years amounted to 95%, 80%, 69%. Cardiac free-event totalled 81% and 76% at 3 and 5 years after CABG. Conclusion: ESCAD patients with bypassable vessels to two or more regions of reversible myocardial ischemia can undergo safe CABG with acceptable hospital and long-term mortality and morbidity. Predictors for poor operative survival in our series appeared to be LVEF < 25%, LVEDP > 28 mmHg, LVEDD > 70 mm, MVI < 0.65, reoperation and arrhythmias. Left ventricular function and heart failure symptoms improved significantly after CABG. Initial postoperative outcome prompted us to consider the beating heart CABG a valuable technique associated with significantly lower postoperative complications.
Early and mid-term outcome of coronary artery bypass grafting in end-stage coronary artery disease patients / Prifti E; Bonacchi M; Frati G; Giunti G; Leacche M; Ballo E; Furci B; Proietti P; Totaro M; Brancaccio G; Comito C; Toscano M.. - In: COR EUROPAEUM. - ISSN 0939-8147. - STAMPA. - Cor Europaeum (2000) 8:93-99.:(2000), pp. 93-99.
Early and mid-term outcome of coronary artery bypass grafting in end-stage coronary artery disease patients
BONACCHI, MASSIMO;
2000
Abstract
To evaluate in a cohort of end-stage coronary artery disease (ESCAD) patients: 1) the effects of coronary artery bypass grafting (CABG) on left ventricular function, operative and mid-term survival; 2) the perioperative benefits of beating heart CABG procedure; 3) the variables predicting poor postoperative ouctome. Methods: Between January 1992 and May 1999, 218 ESCAD patients underwent CABG. Mean age was 65.7 ± 4.5 (range 59-77), males 146. NYHA and CCS class were 3.2 ± 1.0 and 3.4 ± 0.7 respectively. 72 (33%) patients had PTCA preoperatively, 139 (64%) patients presented triple vessel disease. LVEF (%) 26.2 ± 6, LVEDP (mmHg) 27.9 ± 6.8 and LVEDD (mm) 69.4 ± 5.7. 46/218 (21%) patients underwent beating heart CABG procedure. At 1 year after CABG, 183 from 188 survivors underwent TI201 scintigraphy. Results: The postoperative mortality was 20 (9%) patients. The LVEDP and LVEDD improved significantly after CABG (p = 0.003 and p = 0.008). LVEF and MVI in surviving patients were significantly higher versus failed CABG (p = 0.009 and p = 0.033). LVEDP and LVEDD were significantly lower in surviving patients (p = 0.011 and p = 0.008). Postoperative low cardiac output, bleeding and renal complications were significantly higher in ESCAD patients undergoing conventional versus beating heart CABG (p = 0.039, p = 0.029 and p = 0.027). At 1 year after the CABG, the LVEF increased signficantly versus immediate postoperative data (p < 0.004). The actuarial survival at 1, 3 and 5 years amounted to 95%, 80%, 69%. Cardiac free-event totalled 81% and 76% at 3 and 5 years after CABG. Conclusion: ESCAD patients with bypassable vessels to two or more regions of reversible myocardial ischemia can undergo safe CABG with acceptable hospital and long-term mortality and morbidity. Predictors for poor operative survival in our series appeared to be LVEF < 25%, LVEDP > 28 mmHg, LVEDD > 70 mm, MVI < 0.65, reoperation and arrhythmias. Left ventricular function and heart failure symptoms improved significantly after CABG. Initial postoperative outcome prompted us to consider the beating heart CABG a valuable technique associated with significantly lower postoperative complications.
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