U Boeken1, P Feindt, J Litmathe, E Gams. 1. Department of Thoracic and Cardiovascular Surgery, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany.
Abstract
OBJECTIVE: CABG-procedures in patients with depressed LV-ejection fraction (LVEF) may still cause complications. In patients with severely impaired LVEF, it is particularly unclear whether a complete revascularization (CR) leads to a better outcome than the possible advantage of a short period of ischemia. This may be reached by a possibly incomplete revascularization (ICR). METHODS: In our department, 263 patients with LVEF < 30% underwent a CABG-procedure between 1996 and 2000. Patients were divided into two groups with regard to their revascularization: group A patients (n = 158) received all grafts that were thought to be necessary according to preoperative angiography, whereas in group B (n = 105) at least one graft could not be realized. RESULTS: Mean number of grafts per patient was 3.59 +/- 0.58 in group A and 2.92 +/- 0.47 in group B (p < 0.05). Intraoperatively, 33% of group A patients needed catecholamines, compared to 48% in group B (p < 0.05). IABP was used more often in group B (n = 7 compared to n = 3 in group A) (p < 0.05). Postoperatively, there were also significant differences: duration of mechanical ventilation (A: 12.1 +/- 3.4 h; B: 20 +/- 5.2 h) (p < 0.05) and stay on ICU (A: 3.0 +/- 0.6 days; B: 4.2 +/- 0.6 days) (p < 0.05) were significantly prolonged in group B patients. Six patients from group B died during hospitalization (6%), compared to five from group A (3.2%) (p < 0.05). CONCLUSIONS: In patients with a severely depressed LVEF, complete revascularization improves the outcome after CABG-procedures. A prolonged time of intraoperative ischemia and CPB can be accepted to realize an effective revascularization.
OBJECTIVE: CABG-procedures in patients with depressed LV-ejection fraction (LVEF) may still cause complications. In patients with severely impaired LVEF, it is particularly unclear whether a complete revascularization (CR) leads to a better outcome than the possible advantage of a short period of ischemia. This may be reached by a possibly incomplete revascularization (ICR). METHODS: In our department, 263 patients with LVEF < 30% underwent a CABG-procedure between 1996 and 2000. Patients were divided into two groups with regard to their revascularization: group A patients (n = 158) received all grafts that were thought to be necessary according to preoperative angiography, whereas in group B (n = 105) at least one graft could not be realized. RESULTS: Mean number of grafts per patient was 3.59 +/- 0.58 in group A and 2.92 +/- 0.47 in group B (p < 0.05). Intraoperatively, 33% of group A patients needed catecholamines, compared to 48% in group B (p < 0.05). IABP was used more often in group B (n = 7 compared to n = 3 in group A) (p < 0.05). Postoperatively, there were also significant differences: duration of mechanical ventilation (A: 12.1 +/- 3.4 h; B: 20 +/- 5.2 h) (p < 0.05) and stay on ICU (A: 3.0 +/- 0.6 days; B: 4.2 +/- 0.6 days) (p < 0.05) were significantly prolonged in group B patients. Six patients from group B died during hospitalization (6%), compared to five from group A (3.2%) (p < 0.05). CONCLUSIONS: In patients with a severely depressed LVEF, complete revascularization improves the outcome after CABG-procedures. A prolonged time of intraoperative ischemia and CPB can be accepted to realize an effective revascularization.