Early Results and Risk Factors of Surgical Revascularization for Patients with Ischemic Heart Disease and Left Ventricular Dysfunction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGRong ,  GAOChang-qing , XIAOCang-song , WUYang , RENChong-lei , GONGZhi-yun , WANGYao , LIUGuo-peng , WANGMing-yan

Department of Cardiovascular Surgery, Peoples Liberation Army General Hospital, Beijing 100853, P. R. China;

Corresponding?author：

GAOChang-qing, Email: gaochq301@yahoo.com

Keywords：

Ischemic heart disease; Coronary artery bypass; Heart failure; Risk factors

DOI：

10.7507/1007-4848.20150238

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Objective To analyze the early results and risk factors of surgical revascularization for patients with ischemic heart disease and left ventricular dysfunction. Methods clinical data of 318 patients with ischemic heart disease and left ventricular dysfunction with left ventricular ejection fraction (LVEF)≤50% who underwent coronary artery bypass grafting (cABG) from January 2003 to July 2013 was retrospectively reviewed. There were 266 males and 52 females with a mean age of 62.6±9.2 years (range 36 to 83). seventy-six patients underwent off-pump cABG (oPcAB) and 242 patients underwent conventional cABG. Fifteen patients underwent concomitant mitral valve repair or replacement. The patients who underwent left ventricular aneurysmectomy (LVA) were excluded from this study. Perioperative data were collected including the risk factors, echocardiographic results, morbidities and mortalities. The risk factors were analyzed with the endpoints of adverse events and mortalities to find the elements that influence the early results of the procedure. Results The EuroscorE Ⅱ predicted operative mortality rate was 2.78±4.02% (range 1.00% to 45.00%) and actual mortality rate was 1.9% (6/318). Three of 6 patients died from low cardiac output syndrome. Totaladverse events rate was 47.2% (150/318) including prolonged ventilation (25.2%), low cardiac output syndrome (6.3%),ventricular arrhythmia (4.4%), acute renal dysfunction (4.1%), myocardial infarction (3.8%), cerebralvascular accident(2.8%), and re-exploration for bleeding (0.6%). Compared with those preoperatively, the LVEF was significantly improvedfrom 42.14%±5.94% to 45.64%±8.33% (t=6.084, P=0.000), and the left ventricular end diastolic dimension (LVEDD) wassignificantly reduced from 53.96±6.28 mm to 48.64±7.50 mm (t=-9.681, P=0.000) postoperatively. The logistic multiplevariables regression analysis showed perioperative intra-aortic balloon pump (IABP) implantation was mutual risk factorof prolonged ventilation and low cardiac output syndrome. Conclusion Surgical revascularization is an effective optionfor patients with ischemic heart disease and left ventricular dysfunction, demonstrated by improved LVEF and reducedLVEDD. Low cardiac output syndrome is the main cause of operative death. Perioperative IABP implantation is mutualrisk factor of prolonged ventilation and low cardiac output syndrome. Meticulous perioperative management plays a keyrole in satisfactory early results.

Citation： WANGRong, GAOChang-qing, XIAOCang-song, WUYang, RENChong-lei, GONGZhi-yun, WANGYao, LIUGuo-peng, WANGMing-yan. Early Results and Risk Factors of Surgical Revascularization for Patients with Ischemic Heart Disease and Left Ventricular Dysfunction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(10): 954-960. doi: 10.7507/1007-4848.20150238 Copy

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2.	Adams KF Jr,Fonarow Gc,Emerman cL,et al.characteristics and outcomes of patients hospitalized for heart failure in the United states:rationale,design,and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National registry(ADHErE).Am Heart J,2005,149(2):209-216.
3.	Gheorghiade M,Bonow ro.chronic heart failure in the United states:a manifestation of coronary artery disease.circulation,1998,97(3):282-289.
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6.	Phillips Hr,o'connor cM,rogers J.revascularization for heart failure.Am Heart J,2007,153(4 suppl):65-73.
7.	Tarakji KG,Brunken r,Mccarthy PM,et al.Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction.circulation,2006,113(2):230-237.
8.	Muhlbaier LH,Pryor DB,rankin Js,et al.observational comparison of event-free survival with medical and surgical therapy in patients with coronary artery disease:20 years of follow-up.circulation,1992,86(5 suppl):Ⅱ198-Ⅱ204..
9.	Velazquez EJ,Lee KL,Deja MA,et al.coronary artery bypass surgery in patients with left ventricular dysfunction.N Engl J Med,2011,364(17):1607-1616.
10.	Velazquez EJ,Williams JB,Yow E,et al.Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting vs.medical therapy.Ann Thorac surg,2012,93(2):523-530.
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14.	Keeling WB,Williams ML,slaughter Ms,et al.off-pump and onpump coronary revascularization in patients with low ejection fraction:a report from the society of thoracic surgeons national database.Ann Thorac surg,2013,96(1):83-89.
15.	Yoo Js,Kim JB,Jun sH.coronary artery bypass grafting in patients with left ventricular dysfunction:Predictors of long-term survival and impact of surgical strategies.Int J cardiol,2013,168(6):5316-5322.
16.	陳振強,陳鑫,趙揚,等.中、重度左室功能減退的冠狀動脈旁路術.南京醫科大學學報(自然科學版),2004,24(3):221-223.
17.	楊敏烈,孫寒松,張瑛,等.冠心病合并左室功能不全患者的非體外循環與體外循環下冠狀動脈旁路移植術早期結果分析.中國微創外科雜志,2009,9(3):261-264.
18.	劉健,袁忠祥.合并嚴重左心功能不全冠心病患者行冠狀動脈旁路移植術的臨床分析.中國胸心血管外科臨床雜志,2011,18(6):574-575.
19.	Hillis LD,smith PK,Anderson JL,et al.2011 AccF/AHA Guideline for coronary Artery Bypass Graft surgery:A report of the American college of cardiology Foundation/American Heart Association Task Force on Practice Guidelines.circulation,2011,124(23):2610-2642.
20.	christenson JT,simonet F,Badel P,et al.optimal timing of preoperative intra-aortic balloon pump support in high-risk coronary patients.Ann Thorac surg,1999,68(3):934-939.
21.	christenson JT,Licker M,Kalangos A.The role of intra-aortic counterpulsation in high-risk oPcAB surgery:a prospective randomized study.J card surg,2003,18(4):286-294.
22.	christenson JT,schmuziger M,simonet F.Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy.cardiovasc surg,2001,9(4):383-390.
23.	ranucci M,castelvecchio s,Biondi A,et al.A randomized controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left ventricular function undergoing coronary artery bypass surgery.crit care Med,2013,41(11):2476-2483.

1. roger VL,Go As,Lloyd-Jones DM,et al.Heart disease and stroke statistics-2012 update:a report from the American Heart Association.circulation,2012,125(1):e2-e220.
2. Adams KF Jr,Fonarow Gc,Emerman cL,et al.characteristics and outcomes of patients hospitalized for heart failure in the United states:rationale,design,and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National registry(ADHErE).Am Heart J,2005,149(2):209-216.
3. Gheorghiade M,Bonow ro.chronic heart failure in the United states:a manifestation of coronary artery disease.circulation,1998,97(3):282-289.
4. Alderman EL,Fisher LD,Litwin P,et al.results of coronary artery surgery in patients with poor left ventricular function(cAss).circulation,1983,68(4):785-795.
5. o'connor cM,Velazquez EJ,Gardner LH,et al.comparison of coronary artery bypass grafting versus medical therapy on longterm outcome in patients with ischemic cardiomyopathy(a 25-year experience from the Duke cardiovascular Disease Databank).Am J cardiol,2002,90(2):101-107.
6. Phillips Hr,o'connor cM,rogers J.revascularization for heart failure.Am Heart J,2007,153(4 suppl):65-73.
7. Tarakji KG,Brunken r,Mccarthy PM,et al.Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction.circulation,2006,113(2):230-237.
8. Muhlbaier LH,Pryor DB,rankin Js,et al.observational comparison of event-free survival with medical and surgical therapy in patients with coronary artery disease:20 years of follow-up.circulation,1992,86(5 suppl):Ⅱ198-Ⅱ204..
9. Velazquez EJ,Lee KL,Deja MA,et al.coronary artery bypass surgery in patients with left ventricular dysfunction.N Engl J Med,2011,364(17):1607-1616.
10. Velazquez EJ,Williams JB,Yow E,et al.Long-term survival of patients with ischemic cardiomyopathy treated by coronary artery bypass grafting vs.medical therapy.Ann Thorac surg,2012,93(2):523-530.
11. Windecker s,Kolh P,Alfonso F,et al.2014 Esc/EAcTs Guidelines on myocardial revascularization.Kardiol Pol,2014,72(12):1253-379.
12. Baker DW,Jones r,Hodges J,et al.Management of heart failure:the role of revascularization in the treatment of patients with moderate or severe left ventricular systolic dysfunction.JAMA,1994,272(19):1528-1534.
13. Kunadian V,Zaman A,Qiu W.revascularization among patients with severe left ventricular dysfunction:a meta-analysis of observational studies.Eur J Heart Fail,2011,13(7):773-784.
14. Keeling WB,Williams ML,slaughter Ms,et al.off-pump and onpump coronary revascularization in patients with low ejection fraction:a report from the society of thoracic surgeons national database.Ann Thorac surg,2013,96(1):83-89.
15. Yoo Js,Kim JB,Jun sH.coronary artery bypass grafting in patients with left ventricular dysfunction:Predictors of long-term survival and impact of surgical strategies.Int J cardiol,2013,168(6):5316-5322.
16. 陳振強,陳鑫,趙揚,等.中、重度左室功能減退的冠狀動脈旁路術.南京醫科大學學報(自然科學版),2004,24(3):221-223.
17. 楊敏烈,孫寒松,張瑛,等.冠心病合并左室功能不全患者的非體外循環與體外循環下冠狀動脈旁路移植術早期結果分析.中國微創外科雜志,2009,9(3):261-264.
18. 劉健,袁忠祥.合并嚴重左心功能不全冠心病患者行冠狀動脈旁路移植術的臨床分析.中國胸心血管外科臨床雜志,2011,18(6):574-575.
19. Hillis LD,smith PK,Anderson JL,et al.2011 AccF/AHA Guideline for coronary Artery Bypass Graft surgery:A report of the American college of cardiology Foundation/American Heart Association Task Force on Practice Guidelines.circulation,2011,124(23):2610-2642.
20. christenson JT,simonet F,Badel P,et al.optimal timing of preoperative intra-aortic balloon pump support in high-risk coronary patients.Ann Thorac surg,1999,68(3):934-939.
21. christenson JT,Licker M,Kalangos A.The role of intra-aortic counterpulsation in high-risk oPcAB surgery:a prospective randomized study.J card surg,2003,18(4):286-294.
22. christenson JT,schmuziger M,simonet F.Effective surgical management of high-risk coronary patients using preoperative intra-aortic balloon counterpulsation therapy.cardiovasc surg,2001,9(4):383-390.
23. ranucci M,castelvecchio s,Biondi A,et al.A randomized controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left ventricular function undergoing coronary artery bypass surgery.crit care Med,2013,41(11):2476-2483.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early Results and Risk Factors of Surgical Revascularization for Patients with Ischemic Heart Disease and Left Ventricular Dysfunction

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