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;
GAOChang-qing, Email: gaochq301@yahoo.com
Ischemic heart disease; Coronary artery bypass; Heart failure; Risk factors
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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