>Cirugía y Cirujanos
>Year 2003, Issue 4
Salazar-Garrido D, Careaga-Reyna G, Argüero-Sánchez R
Myocardial revascularization in patients with ischemic heart disease and left ventricular dysfunction
Cir Cir 2003; 71 (4)
PDF: 67.48 Kb.
Background: 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
||Myocardial revascularization, left ventricular dysfunction, myocardial hibernation.
Guadalajara JF. Cardiología. 4th ed. México: Editorial Méndez Cervantes; 1991:pp.827-961.
Kirklin J. Cardiac surgery. 2nd ed. Vol. I. USA: Churchill Livingstone; 1993:pp.286-370.
Davidoff R, Ewy G, Fonger J, Gardner T, et al. ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery. J Am Coll Cardiol 1999;34(4):1262-1346.
Ryan T, Bauman W, King S, Kenedy J, et al. Guidelines for Percutaneus Transluminal Coronary Angioplasty. JACC 1993 December;22(7):2033-2054.
Sato T, Isomura Y, Suma H, Horji T. Coronary artery bypass with gastroepiploic artery composite graft. Ann Thorac Surg 2000;69:65-69.
Braunwald E, Antmon E, Beasley J, Califf R, et al. ACC/AHA Guidelines for Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction Executive Summary and Recommendations. Circulation 2000;102:1193-1209.
Grundy S, Pastermah R, Greenland P, Smiht S, et al. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations. Circulation 1999;100:1481-1492.
Antman E, Brooks N, Califf R, Rapapport E, Riegel B. ACC/AHA Guidelines for the Management of Patients with Acute Myocardial Infarction. J Am Coll Cardiol 1999;39(3):890-911.
Mickleboroogh L, Carson S, Tamariz M, Cuanou J. Results of revascularization in patients with severe left ventricular dysfunction. J Thorac Cardiovasc Surg 2000;119:550-557.
John R, Choudhri A, Weiriberg A, Ting W, Rose E, Smith C. Multicenter Review of Preoperative Risk Factors for Stroke After Coronary Artery Bypass Grafting. Ann Thorac Surg 2000;69:30-36.
Chistaks G, Weisel R, Fremess, Ivanov J, et al. Coronary artery bypass grafting in patients with poor ventricular function. J Thorac Cardiovasc Surg 1992;103:1083-1092.
Di Corli M, Maddahi J, Rokhsar S, Sehelbert H, et al. Long term survival of patients with coronary artery disease and left ventricular dysfunction, implications for the role of myocardial viability assessment in management decisions. J Thorac Cardiovasc Surg 1998;116:997-1004.
Chaudhry F, Tauke J, Alessandini R, Vardi G, et al. Prognostic implication of myocardial contractile reserve in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol 1999;34:730-738.
Yau T, Fedack P, Weisel R, Teng C, Ivanov J. Predictors of operative risk for coronary bypass operations in patients with left ventricular dysfunction. J Thorac Cardiovasc Surg 1999;118:1006-1013.
Pigott J, Kouchoukos N, Oberman H, Cutter G. Late results of surgical and medical therapy for patients with coronary artery disease and depressed left ventricular function. J Am Coll Cardiol. 1985;5:1036-1045.
Fallavollita J, Logue M, Canty J. Stability of hybernating myocardium in pigs with a chronic left anterior descending coronary artery stenosis: absence of progressive fibrosis in the setting of stable reductions in flow function and coronary flow reserve. J Am Coll Cardiol 2001;37:1989-1995.
Vanoverschelde JL, Winjns W, Depré C, Essamri B, et al. Mechanisms of chronic regional postischemic dysfunction in humans. Circulation 1993;87:1513-1523.
Schwarz E, Shoendube F, Kostin S, Schmiedtke N, Shulz G, Buell V, et al. Prolonged myocardial hibernation exacerbates cardiomyocyte degeneration and impairs recovery of function after revascularization. J Am Coll Cardiol 1998;31:1018-1026.
Maes A, Flammeng W, Nuyts J, Borges M, Shivalkar B, Asomo J, et al. Histological alterations chronically hypoperfused myocardium correlation with PET findings. Circulation 1994;90:735-745.
Fitzman D, Al Aovar Z, Kanter H, Vom Dahl J, Kirsh M, et al. Clinical outcome of patients with advanced coronary artery disease after viability studies with positron emission tomography. J Am Coll Cardiol 1992;20:559-565.
Pasini E, Ferrari G, Cremore G. Revasculation of severe hibernating myocardium in the beating heart: early hemodynamic and metabolic features. Ann Thorac Surg 2001;71:176-179.
Luciani G, Faggian G, Razzolini R, Livi V, Bortolotti U, et al. Severe ischemic left ventricular failure: coronary operation or heart transplantation. Ann Thorac Surg 1993;55:719-723.
>Cirugía y Cirujanos
>Year 2003, Issue 4