Clinical Results of Coronary Revascularization in Left Ventricular Dysfunction

Lee, Sak; Chang, Byung‐Chul; Yoo, Kyung-Jong; Hong, Young Ho; Kang, Meyun-Shick

doi:10.1253/circj.71.1862

Cited by 14 publications

(16 citation statements)

References 17 publications

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“…The steep operative mortality in the LEF group (13.5%) was considerably higher compared to the published mortality of non-reoperative (first time) cardiac surgery patients with low LVEF (5.6% to 11%) (13)(14)(15) and to the previously published operative mortality in all re-AVR patients (4.5% to 5.1%) (8,9), to which the 3.2% mortality of our re-AVR HEF group compares favorably. The contrasting outcomes of re-AVR LEF patients to both HEF and historic groups stress the increased risk conferred by the presence of low ventricular contractility and a prior sternotomy.…”

Section: Discussioncontrasting

confidence: 58%

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Yammine

Val

Ejiofor

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Patient comorbidities play a pivotal role in the surgical outcomes of reoperative aortic valve replacement (re-AVR). Low left ventricular ejection fraction (LVEF) and renal insufficiency (Cr >2 mg/dL) are known independent surgical risk factors. Improved preoperative risk assessment can help determine the best therapeutic approach. We hypothesize that re-AVR patients with low LVEF and concomitant renal insufficiency have a prohibitive surgical risk and may benefit from transcatheter AVR (TAVR).Methods: From January 2002 to March 2013, we reviewed 232 patients who underwent isolated re-AVR.Patients older than 80 years were excluded to adjust for unobserved frailty. We identified 37 patients with a ≤35% LVEF (low ejection fraction group-LEF) and 195 patients with >35% LVEF (High ejection fraction group-HEF).Results: The mean age was 68.4±11.5 years and there were more females (86.5% versus 64.1%, P=0.007) in the LEF group. The prevalence of renal insufficiency was higher in LEF patients (27% versus 5.6%, P=0.001).Higher operative mortality (13.5% versus 3.1%, P=0.018) was observed in the LEF group. Stroke rates were similar in both groups (8.1% versus 4.1%, P=0.39). Unadjusted cumulative survival was significantly lower in LEF patients (6.6 years, 95% CI: 5.2-8.0, versus 9.7 years, 95% CI: 8.9-10.4, P=0.024). In patients without renal insufficiency, LEF and HEF had similar survival (8.3 years, 95% CI: 7.1-9.5, versus 9.9 years, 95% CI:9.1-10.6, P=0.90). Contrarily, in patients with renal insufficiency, LEF led to a significantly lower survival (1.1 years, 95% CI: 0.1-2.0, versus 4.8 years, 95% CI: 2.2-7.3, P=0.050). Adjusted survival analysis revealed elevations in baseline creatinine (HR =4.28, P<0.001) and LEF (HR =5.33, P=0.041) as significant predictors of long-term survival, with a significant interaction between these comorbidities (HR =7.28, P<0.001). Conclusions:In re-AVR patients, low LVEF (≤35%) is associated with increased operative mortality.Concomitant renal insufficiency in these patients results in a prohibitively low cumulative survival. These reoperative surgical outcomes should warrant expanding the role of TAVR for reoperative patients with LEF and renal impairment.

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Section: Discussioncontrasting

confidence: 58%

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Yammine

Val

Ejiofor

et al. 2017

Ann. Cardiothorac. Surg.

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“…In a study by Shah and colleagues [20], the 5-year survival rate in patients with an EF of < 35% was 55%, and the 10-year survival rate was 23.9%. In a recent study of patients with an EF of ≤ 30, approximately 80% were alive 5 years after surgery, and 45% were alive 10 years after surgery [24]. A 20-year survival study by Weintraub and colleagues showed that a low EF independently predicted poor long-term survival after CABG, although the subjects experienced good relief from angina [25].…”

Section: Discussionmentioning

confidence: 99%

“…Case selection has been shown to be an important factor in achieving a favorable outcome after CABG in patients with a low EF [24]. Our study included patients without preoperative viability test results and those with a ventricular aneurysm or associated mild or moderate mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

Hamad

Straten

Schönberger

et al. 2010

J Cardiothorac Surg

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Background Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting. Methods Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation. Results and Discussion One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of < 50%. In subjects with a preoperative ejection fraction of > 50%, long-term survival exceeded expected survival. Conclusions The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%.

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“…Within this study group, the early mortality was significantly decreased from 11.8% in the first half of the study period to 6.7% in the second half of the study period. Improvement in early outcome of patients with low EF has been attributed to improved operative techniques and better patient preoperative screening and selection 17 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Prediction of Early Mortality in Patients with Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting

Hamad

Straten

M.D.

et al. 2010

Journal of Cardiac Surgery

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Clinical Results of Coronary Revascularization in Left Ventricular Dysfunction

Cited by 14 publications

References 17 publications

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Parsimonious assessment for reoperative aortic valve replacement; the deterrent effect of low left ventricular ejection fraction and renal impairment

Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

Preoperative Prediction of Early Mortality in Patients with Low Ejection Fraction Undergoing Coronary Artery Bypass Grafting

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