2003, Number 4
Myocardial revascularization in patients with ischemic heart disease and left ventricular dysfunction
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ABSTRACTBackground: Operative morbidity and mortality in coronary artery bypass surgery has decreased over the last decades and coronary artery bypass surgery offers an increase in long-term survival in selected patients with lower ejection fraction. We do not know exactly the results of the surgery and evolution of our patients with chronic lower ejection fraction. Objective: To evaluate clinical results of myocardial revascularization in patients with ischemic heart disease and chronic lower ejection fraction. Material and methods: We analyzed the experience between January 2000 and December 2001 of patients with ejection fraction = 30% treated with surgical myocardial revascularization. The procedure was carried out with cardiopulmonary bypass and moderate hypothermia (30°C), and myocardial protection with intermittent cold crystalloid cardioplegia. We evaluated demographic characteristics, surgical procedure carried out, length-of-stay in intensive postoperative care unit, and morbidity and mortality in perioperative period and in middle term follow-up. Results: During this period, 738 patients were treated with aorto-coronary bypass surgery Thirty eight patients were patients with chronic lower ejection fraction (5.14%) and were included in this evaluation. Six patients were female (15.78%), and 32 males (84.21%). Range of duration of cardiopulmonary bypass was 65-245 min (mean, 123 min), range of aortic cross-clamping time was 30-120 min (mean, 59 min). Twelve month follow-up showed improvement in two functional classes in 15 patients (39.4%), and improvement in one functional class in 10 patients (26.3%); two patients remained in the same functional class (5.2%), and one patient decreased his/her functional class (2.6%). Mean of length-of-stay in intensive care unit was 6.5 days and in hospital, 12.5 days. Perioperative morbility was 34.2% and same-pe riod mortality was 26%; 12 month survival was 74%. It was concluded that even with high mortality as in other series, survival and quality of life of these patients is better with than medical therapy.
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