PMID- 9386693
OWN - NLM
STAT- MEDLINE
DCOM- 19971223
LR  - 20061115
IS  - 0003-4975 (Print)
IS  - 0003-4975 (Linking)
VI  - 64
IP  - 5
DP  - 1997 Nov
TI  - Decision-making in end-stage coronary artery disease: revascularization or heart 
      transplantation?
PG  - 1296-301; discussion 1302
AB  - BACKGROUND: Left ventricular function is the most important predictor of survival 
      in patients with coronary artery disease. It is also an important indicator for 
      hospital and late mortality after operation for endstage coronary artery disease. 
      METHODS: Between April 1986 and December 1994, 514 patients with end-stage 
      coronary artery disease and left ventricular ejection fraction between 0.10 and 
      0.30 underwent coronary artery bypass grafting at the German Heart Institute 
      Berlin. Two hundred twenty-five of these patients had been referred as possible 
      candidates for heart transplantation. The prime criterion for bypass grafting was 
      ischemia diagnosed by myocardial scintigraphy and echocardiography ("hibernating 
      myocardium"). RESULTS: Operative mortality for the group was 7.1%. The actuarial 
      survival rate was 90.8% after 2 years, 87.6% after 4, and 78.9% after 6. Left 
      heart catheterizations performed 1 year after the operation showed that left 
      ventricular ejection fraction had increased from a mean of 0.24 +/- 0.03 
      preoperatively to 0.39 +/- 0.06 postoperatively (p < 0.0001). Preoperatively 
      91.6% of the patients were in New York Heart Association (NYHA) class III or IV; 
      6 months postoperatively 90.2% of the surviving patients were in NYHA class I or 
      II. Two hundred thirty-one patients with end-stage coronary artery disease and 
      predominant heart failure underwent heart transplantation. Their actuarial 
      survival rate was 74.9% after 2 years, 73.2% after 4, and 68.9% after 6. All of 
      the patients could be recategorized into NYHA class I or II after the operation. 
      CONCLUSIONS: We conclude that coronary artery bypass grafting and heart 
      transplantation can be used successfully to improve the life expectancy of 
      patients with end-stage coronary artery disease. Coronary artery bypass grafting 
      leads to an excellent prognosis for these high-risk patients when the myocardium 
      is preoperatively identified as being viable.
FAU - Hausmann, H
AU  - Hausmann H
AD  - Department of Thoracic and Cardiovascular Surgery, German Heart Institute Berlin, 
      Germany.
FAU - Topp, H
AU  - Topp H
FAU - Siniawski, H
AU  - Siniawski H
FAU - Holz, S
AU  - Holz S
FAU - Hetzer, R
AU  - Hetzer R
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Actuarial Analysis
MH  - Adult
MH  - Cardiac Output, Low/mortality/surgery
MH  - *Coronary Artery Bypass/mortality
MH  - Coronary Disease/mortality/physiopathology/*surgery
MH  - Female
MH  - *Heart Transplantation/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications
MH  - Prospective Studies
MH  - Stroke Volume
MH  - Survival Rate
MH  - Ventricular Pressure
EDAT- 1997/12/05 00:00
MHDA- 1997/12/05 00:01
CRDT- 1997/12/05 00:00
PHST- 1997/12/05 00:00 [pubmed]
PHST- 1997/12/05 00:01 [medline]
PHST- 1997/12/05 00:00 [entrez]
AID - S0003-4975(97)00805-9 [pii]
AID - 10.1016/S0003-4975(97)00805-9 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 1997 Nov;64(5):1296-301; discussion 1302. doi: 
      10.1016/S0003-4975(97)00805-9.