PMID- 7655730
OWN - NLM
STAT- MEDLINE
DCOM- 19951005
LR  - 20191023
IS  - 0954-6928 (Print)
IS  - 0954-6928 (Linking)
VI  - 6
IP  - 5
DP  - 1995 May
TI  - Is reoperative coronary artery bypass grafting in patients with poor left 
      ventricular ejection fractions < or = 25% worthwhile?
PG  - 423-8
AB  - AIM: This study aimed to investigate whether patients with very low left 
      ventricular ejection fractions (LVEF) should be accepted for reoperative coronary 
      artery bypass grafting (CABG). STUDY POPULATION: Between January 1990 and 
      December 1993, 1681 patients underwent primary CABG and 308 (15.5%) reoperative 
      CABG. One hundred and eight patients (5.4%) had an LVEF < or = 25%, 91 patients 
      for primary CAGB (group I) and 17 for CABG (group II). The mean age of the 
      patients was 62 years. Sex distribution and preoperative risk factors did not 
      differ. Urgent operations were more frequently necessary in group II (P < 0.01). 
      Mitral regurgitation was present in 49% of the group I patients and 18% of the 
      group II patients (P < 0.05). Pulmonary artery hypertension was observed in 24% 
      of group I patients, but in only 6% in group II patients. The mean LVEF was 21% 
      and left ventricular end-diastolic pressure 18 mmHg, without between-group 
      differences. All patients had significant two- or three-vessel disease (stenosis 
      > or = 70%). An average of 4.5 grafts per patient were performed. Mitral valve 
      surgery was not performed in any of the patients. RESULTS: The postoperative 
      mortality was significantly higher in reoperative CABG patients (group II; 23.5%) 
      than in group I patients (12.1%; P < 0.05), whereas the incidence of non-fatal 
      myocardial infarction did not differ. The incidence of postoperative 
      complications did not differ between the groups, except for transient renal 
      failure, more frequently encountered in group II (P < 0.05). After an average 
      follow-up of 18 months, the New York Heart Association (NYHA) class and the LVEF 
      were significantly improved in both groups (NYHA class from 3.5 to 1.8 and LVEF 
      from 21% to 45%; P < 0.001). The mitral regurgitation had improved or completely 
      disappeared at the end of follow-up in all patients in both groups. CONCLUSIONS: 
      Our results suggest that patients with left ventricular ejection fraction < or = 
      25%, angina and significant two- or three-vessel coronary artery disease should 
      not categorically be refused for reoperative CABG. Careful patient selection is 
      necessary because of an increased operative risk.
FAU - Christenson, J T
AU  - Christenson JT
AD  - Cardiovascular Surgery Unit, Hopital de la Tour, Meyrin-Geneva, Switzerland.
FAU - Bloch, A
AU  - Bloch A
FAU - Maurice, J
AU  - Maurice J
FAU - Simonet, F
AU  - Simonet F
FAU - Velebit, V
AU  - Velebit V
FAU - Schmuziger, M
AU  - Schmuziger M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Coron Artery Dis
JT  - Coronary artery disease
JID - 9011445
SB  - IM
MH  - Case-Control Studies
MH  - Contraindications
MH  - *Coronary Artery Bypass
MH  - Coronary Disease/complications/mortality/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Hypertension, Pulmonary/complications
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/complications
MH  - Patient Selection
MH  - Postoperative Complications/mortality
MH  - Reoperation
MH  - Risk Factors
MH  - Stroke Volume
MH  - Time Factors
MH  - Ventricular Dysfunction, Left/*complications
EDAT- 1995/05/01 00:00
MHDA- 1995/05/01 00:01
CRDT- 1995/05/01 00:00
PHST- 1995/05/01 00:00 [pubmed]
PHST- 1995/05/01 00:01 [medline]
PHST- 1995/05/01 00:00 [entrez]
AID - 10.1097/00019501-199505000-00010 [doi]
PST - ppublish
SO  - Coron Artery Dis. 1995 May;6(5):423-8. doi: 10.1097/00019501-199505000-00010.