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THE 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
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ORIGINAL ARTICLES CARDIAC PAPERS
The Journal of Cardiovascular Surgery 1999 Dicembre;40(6):773-80
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
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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.