Predictors of outcome after coronary bypass surgery in patients with left ventricular dysfunction

Sol ventrikül disfonksiyonu olan hastalarda koroner bypass cerrahisinin sonuçlarının belirleyicileri

Ali TELLİ, Anıl Ziya APAYDIN, Mustafa ÖZBARAN, İsa DURMAZ, Fatih İSLAMOĞLU, Münevver YÜKSEL

Özet

Amaç: Çalışmamızın amacı ileri sol ventrikül (LV) disfonksiyonu ile birlikte koroner arter hastalığı olan olgularda uygulanan koroner arter bypass cerrahisi (CABG) operasyonlarındaki postoperatif mortalite ve morbiditeye etkili risk faktörlerini değerlendirmektir. Yöntem: Merkezimizde 1995 ve 2000 yıllan arasında CABG uygulanan ve sol ventrikül ejeksiyon fraksiyonu (LVEF) 60 dk) ve bypass (>120 dk) süreleri, ileri aniinal ve fonksiyonel semptomlar, mortaliteye etkili risk faktörleri olarak saptanmıştır. Bununla birlikte multivaryans analizlerinde sadece ileri yaş ve ileri anjinal ve fonksiyonel semptomlar mortalite ve morbiditede belirleyici oldukları görülmüştür. Sonuç: Postoperatif izlemlerde saptadıgımız düşük mortalite ve morbidite oranları yanında fonksiyonel kapasite ve ejeksiyon fraksiyonlarındaki anlamlı artışlar, sol ventrikül disfonksiyonlu olgularda bir canlılık degerlendirilmesine gerek olamadan yapılan cerrehi revaskülarizasyonnun güvenirliligini göstermektedir. İleri yaş ve ileri anjinal ve fonksiyonel semptomlar bu tür olgularda CABG sonrası kötü prognozda belirleyici faktörlerdir.

Abstract

Objective: The aim of this study was to determine the risk factors affecting the mortality and morbidity after coronary artery bypass grafting (CABG) in patients with LV dysfunction and without any viability assessment. Methods: The preoperative, perioperative, and postoperative early and mid-term follow-up data of 252 patients with left ventricular ejection fraction (LVEF) of $leq$30% who underwent isolated CABG from 1995 through 2000, were evaluated. No preoperative viability study was performed for patient selection. Preoperative echocardiography and cardiac catheterization, and postoperative control echocardiography were performed in all patients. Follow-up data after the discharge of these patients were obtained via monthly periodical examinations in the first 6 months, and thereafter via telephone interviews. As preoperatively, 229 (90.87%) patients were in NYHA class III or IV, and the mean LVEF was 26.58±3.66%. Results: Overall mortality and late mortality rates were 16.27% and 5.16%, respectively. Postoperative complications were observed in 61 (24.21%) patients. During 49.06±15.17 months of follow-up, 185 (93.43%) of 198 (78.57%) survived patients were in NYHA class I or II and the mean LVEF was 39.64%±5.68%. Advanced age, diabetes, hypertension, cross-clamp time >60 min, bypass time>120 min, severity of angina and functional classes (class III-IV of NYHA and CCS) were found to be the determinants of mortality. However, by multivariate analysis only older age and class III-IV of NYHA and CCS were detected as predictors of mortality. Conclusion: The low mortality and morbidity rates as well as postoperative improvements in functional capacity and in LVEF support the use of CABG without the need of any viability assessment in patients with left ventricular dysfunction. Advanced age, severe angina and functional symptom status seem to be the predictors of poor prognosis in these patients after CABG.