Coronary artery bypass grafting in patients with poor ventricular function

G. T. Christakis, R. D. Weisel, S. E. Fremes, J. Ivanov, T. E. David, B. S. Goldman, Tomas Salerno

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

Although patients with severe ventricular dysfunction have improved long- term survival times after coronary bypass procedures, operative morbidity and mortality rates remain high. This study was designed to identify the contemporary risk factors for isolated coronary artery bypass grafting in this high-risk subgroup. Between January 1982 and December 1990, a total of 12,471 patients underwent isolated coronary artery bypass grafting. The 9445 patients with preoperative ejection fractions greater than 40% had a lower operative mortality rate (2.3%) than that of the 2539 patients with ejection fractions between 20% and 40% (4.8%) and that of the 487 patients with ejection fractions less than 20% (9.8%; p < 0.001). However, patients with ejection fractions of less than 20% were demographically distinct from those with higher ejection fractions. This group was older, with fewer women, a higher frequency of left main stenosis, and more frequent requirement of urgent operation for unstable angina. The risk factors for operative death also varied with preoperative ejection fraction. The traditionally accepted risk factors-urgency of operation, left main coronary artery stenosis, reoperation, sex, and age-were predictive of risk of operative death for patients with ejection fractions greater than 40%. The risk of operative death for patients with ejection fractions between 20% and 40% was predicted by urgency of operation, reoperation, sex, myocardial protection, and age. The only predictor of risk of operative death for patients with ejection fractions less than 20% was urgency of operation. Patients undergoing isolated coronary artery bypass grafting who have severe ventricular dysfunction are therefore a highly selected, high-risk subgroup of patients whose risk depends on the urgency of operation. Strategies to improve the results in these patients should be focused on patient selection, improvement of myocardial protection, and more aggressive preoperative treatment of myocardial ischemia.

Original languageEnglish
Pages (from-to)1083-1092
Number of pages10
JournalJournal of Thoracic and Cardiovascular Surgery
Volume103
Issue number6
StatePublished - Jan 1 1992
Externally publishedYes

Fingerprint

Ventricular Function
Coronary Artery Bypass
Ventricular Dysfunction
Reoperation
Mortality
Coronary Stenosis
Unstable Angina
Operative Surgical Procedures
Patient Selection
Myocardial Ischemia
Pathologic Constriction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Christakis, G. T., Weisel, R. D., Fremes, S. E., Ivanov, J., David, T. E., Goldman, B. S., & Salerno, T. (1992). Coronary artery bypass grafting in patients with poor ventricular function. Journal of Thoracic and Cardiovascular Surgery, 103(6), 1083-1092.

Coronary artery bypass grafting in patients with poor ventricular function. / Christakis, G. T.; Weisel, R. D.; Fremes, S. E.; Ivanov, J.; David, T. E.; Goldman, B. S.; Salerno, Tomas.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 103, No. 6, 01.01.1992, p. 1083-1092.

Research output: Contribution to journalArticle

Christakis, GT, Weisel, RD, Fremes, SE, Ivanov, J, David, TE, Goldman, BS & Salerno, T 1992, 'Coronary artery bypass grafting in patients with poor ventricular function', Journal of Thoracic and Cardiovascular Surgery, vol. 103, no. 6, pp. 1083-1092.
Christakis GT, Weisel RD, Fremes SE, Ivanov J, David TE, Goldman BS et al. Coronary artery bypass grafting in patients with poor ventricular function. Journal of Thoracic and Cardiovascular Surgery. 1992 Jan 1;103(6):1083-1092.
Christakis, G. T. ; Weisel, R. D. ; Fremes, S. E. ; Ivanov, J. ; David, T. E. ; Goldman, B. S. ; Salerno, Tomas. / Coronary artery bypass grafting in patients with poor ventricular function. In: Journal of Thoracic and Cardiovascular Surgery. 1992 ; Vol. 103, No. 6. pp. 1083-1092.
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