Criteria for operability and reduction of surgical mortality in patients with severe left ventricular ischemia and dysfunction.

A series of 188 patients who were operated on for left ventricular ischemia and dysfunction is presented. Angina was a prominent symptom in all patients, and a history of congestive heart failure could be elicited in 20%. Mean ejection fraction for the series was 0.35, with 67% having an ejection fraction of 0.35 or less 24%, 0.20 or less. Complete revascularization was accomplished whenever possible; more than 70% of the patients had triple-vessel disease, and single bypass was performed infrequently (5%). Factors thought to be important in achieving a low operative mortality (2.1%) were: precise prebypass monitoring, particularly with the V5 precordial lead; maintaining a low rate-pressure product (less than 12,000) prior to bypass; myocardial preservation with cold hyperkalemic or hyperkalemic-hyperosmolar solution; and careful titration of inotropic and vasodilator drugs. Inotropic drugs and intraaortic balloon pumping were used frequently in this series. The late mortality was 4.3%. Angina was completely relieved or improved in 94% of the patients. Those having a history of congestive heart failure had an increased late mortality rate, four times that of the entire series.