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FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 1999 Dicembre;40(6):773-80

CARDIAC PAPERS 

 ORIGINAL ARTICLES

Transplantation ver­sus cor­o­nary ­artery ­bypass in ­patients ­with ­severe ven­tric­u­lar dys­func­tion. Surgical out­come and qual­ity of ­life

Shum-Tim D., Pelletier M. P.*, Latter D. A., De Varennes B. E., Morin J. E.

From the Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
*Division of Cardiothoracicy Surgery, Montreal General Hospital McGill University, Montreal, Quebec, Canada

Background. The pur­pose of ­this ­study is to eval­u­ate the qual­ity of ­life, func­tion­al stat­us and sur­vi­val ­rate of ­patients ­with ­left ven­tric­u­lar ejec­tion frac­tion (­LVEF) ≤20% fol­low­ing cor­o­nary ­bypass (­CABG) ver­sus ­heart trans­plan­ta­tion.
Methods. Experimental ­design: comparative ­study, ­mean fol­low-up of 20 ­months. Setting: division of car­diac sur­gery at a McGill University-­based hos­pi­tal in Montreal, Canada. Patients: the ­charts of 65 con­sec­u­tive ­patients ­with angio­graph­ic ­LVEF ≤ 20% ­were ­reviewed. Among ­these ­patients, 14/65 ­were ­referred for trans­plan­ta­tion but ­instead under­went ­CABG (Group I) ­after con­sul­ta­tion ­with the trans­plant com­mit­tee. The ­charts of 14 ­matched trans­plant ­patients (Group II) ­were ­reviewed. The SF-36 and Duke’s ques­tion­naire ­forms ­were ­mailed to ­both ­groups in ­order to eval­u­ate ­their qual­ity of ­life and func­tion­al capac­ity, respec­tive­ly. Interventions: comparison ­between cor­o­nary ­bypass and ­heart trans­plan­ta­tion. Measures: main out­come meas­ures ­were mor­tal­ity, qual­ity of ­life, and func­tion­al capac­ity.
Results. Results are ­expressed as ­mean±SEM. The in-hos­pi­tal mor­tal­ity ­rate of ­CABG ­among all ­patients ­with ­LVEF ≤ 20% was 4.6% (3/65). Among the 14 ­CABG ­patients initial­ly ­referred for trans­plan­ta­tion, per­i­op­er­a­tive mor­tal­ity was 1/14 (7.1%), ­same as in the ­matched trans­plant ­group. Three addi­tion­al ­group I ­patients ­were report­ed by fam­i­ly to ­have ­died of car­diac ­events at fol­low-up peri­od. Postoperative ­death iden­ti­fied at fol­low-up was ­assigned the low­est ­life qual­ity ­score. The trans­formed qual­ity of ­life ­scores ­were as fol­lows: phys­i­cal func­tion­ing: I=42.5±10.6, II=73.2±7.2, p=0.029; phys­i­cal ­role: I=35.0± 13.5, II=61.4±13.2, p=0.180; bod­i­ly ­pain: I=54.0±14.0, II=69.8±8.5, p=0.349; gen­er­al ­health: I=34.7±9.2, II=84.6 ±5.2, p=0.0003; vital­ity: I=36.5±9.3, II=60.0±5.2, p=0.045; ­social func­tion­ing: I=55.0±4.0, II=87.5±5.1, p=0.050; emo­tion­al ­role: I=36.7±15.3, II=87.9±6.8, p=0.009; men­tal ­health: I=52.8±12.4, II=81.5±4.2, p=0.054. Duke’s activ­ity stat­us ­index: I=16.8±4.2, II=31.8±4.2, p=0.021.
Conclusions. Heart trans­plant is asso­ciat­ed ­with a sig­nif­i­cant­ly super­i­or post­op­er­a­tive qual­ity of ­life and func­tion­al capac­ity ­than ­bypass sur­gery. However, in ­patients ­with ­LVEF ≤ 20%, ­CABG can be per­formed ­with an accept­able per­i­op­er­a­tive mor­tal­ity of 4.6%-7.1%, sim­i­lar to the ­rate for trans­plan­ta­tion.

lingua: Inglese


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