INTRODUCTION: In patients with chronic ischemic heart disease, a severe ventricular dysfunction is associated with a higher operative risk and to a worse late clinical outcome. However, when there is sufficient viable myocardium, surgical revascularization can improve ventricular performance and above all the functional capacity and survival of these patients. OBJECTIVES: To analyze long-term results of a large series of patients with an ejection fraction < or = 0.30 that underwent isolated coronary artery bypass surgery and to investigate factors, mainly clinical, that determined favorable clinical results: being that the patient was alive and free of incapacitating symptoms. PATIENTS AND METHODS: This series included 100 patients, 93 males and 7 females, with a mean age of 62 +/- 8 years. The predominant clinical manifestation was angina in 37, congestive heart failure in 22 and both in 41. Seventy-nine patients were in functional class III or IV, and 19 had emergency surgery. RESULTS: There were 10 in-hospital deaths, 6 of which occurred in patients who had emergency surgery. Mortality in the elective cases was 4.9%. Only age (p < 0.05), functional class (p < 0.05) and emergency surgery (p < 0.0001) were identified as independent predictors of early mortality. Actuarial survival rates after 5 and 8 years were 65 and 52% respectively. Long-term clinical outcome was considered favorable in 66 patients. We did not find any preoperative clinical variables that were predictors of the clinical outcome. Only preoperative mitral insufficiency correlated with a poor long-term clinical result. CONCLUSIONS: Patients with chronic and severe ventricular dysfunction secondary to coronary artery disease have an acceptable surgical risk when they are operated on electively, before their clinical condition deteriorates. Long-term results are satisfactory in the majority of the patients. In these types of patients clinical manifestations are of limited value in the selection process for surgical revascularization.
INTRODUCTION: In patients with chronic ischemic heart disease, a severe ventricular dysfunction is associated with a higher operative risk and to a worse late clinical outcome. However, when there is sufficient viable myocardium, surgical revascularization can improve ventricular performance and above all the functional capacity and survival of these patients. OBJECTIVES: To analyze long-term results of a large series of patients with an ejection fraction < or = 0.30 that underwent isolated coronary artery bypass surgery and to investigate factors, mainly clinical, that determined favorable clinical results: being that the patient was alive and free of incapacitating symptoms. PATIENTS AND METHODS: This series included 100 patients, 93 males and 7 females, with a mean age of 62 +/- 8 years. The predominant clinical manifestation was angina in 37, congestive heart failure in 22 and both in 41. Seventy-nine patients were in functional class III or IV, and 19 had emergency surgery. RESULTS: There were 10 in-hospital deaths, 6 of which occurred in patients who had emergency surgery. Mortality in the elective cases was 4.9%. Only age (p < 0.05), functional class (p < 0.05) and emergency surgery (p < 0.0001) were identified as independent predictors of early mortality. Actuarial survival rates after 5 and 8 years were 65 and 52% respectively. Long-term clinical outcome was considered favorable in 66 patients. We did not find any preoperative clinical variables that were predictors of the clinical outcome. Only preoperative mitral insufficiency correlated with a poor long-term clinical result. CONCLUSIONS:Patients with chronic and severe ventricular dysfunction secondary to coronary artery disease have an acceptable surgical risk when they are operated on electively, before their clinical condition deteriorates. Long-term results are satisfactory in the majority of the patients. In these types of patients clinical manifestations are of limited value in the selection process for surgical revascularization.