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The Journal of Cardiovascular Surgery 2019 June;60(3):396-405

DOI: 10.23736/S0021-9509.19.10670-2


lingua: Inglese

Coronary artery bypass grafting in patients with low ejection fraction: what are the risk factors?

Keeran VICKNESON 1, Siew-Pang CHAN 2, 3, Yue LI 4, Muhammad N. BIN ABDUL AZIZ 5, Hai D. LUO 4, Giap S. KANG 4, Michael G. CALEB 4, Vitaly SOROKIN 4, 5, 6

1 School of Medicine, University of Dundee, Dundee, UK; 2 Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3 College of Science, Health and Engineering, La Trobe University, Melbourne, Australia; 4 Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore; 5 Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 6 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

BACKGROUND: Left ventricular (LV) dysfunction alone is insufficient as an independent predictor of postoperative complications and mortality in coronary artery bypass graft (CABG) surgery. Our objective was to identify additional independent risk factors in patients with low left ventricle ejection fraction (EF) who underwent CABG.
METHODS: We retrospectively analyzed CABG results of 346 consecutive patients with low EF (≤30%) in a single institution between 2009 and 2015. The primary study endpoint was 30-day all-cause mortality. The secondary endpoints were the development of major adverse cardiac events (MACE) and renal complications after operation. A subgroup of patients underwent additional analyses of the interaction between extents of viable myocardium and postoperative endpoints.
RESULTS: The analysis showed that preoperative hemodynamic instability (AOR=4.57; 95% CI: 1.53-13.7, P=0.007) and serum creatinine >166 µmol/L (AOR=3.46; 95% CI: 1.12-10.7, P=0.031) were independent predictors of 30-day death. Both urgent and emergency operations were predictors for MACE (P=0.038; P=0.005) and renal complications (P=0.004; P=0.007). Pre-existing diabetes mellitus increased the likelihood of renal complications (P=0.020). In the sub-analysis of patients with viable myocardium, the mortality was significantly lower with predicted mortality (P=0.014).
CONCLUSIONS: Patients with significant LV dysfunction undergoing isolated CABG have fair short-term survival even with EF less than 30%. Hemodynamic instability prior to operation and preoperative kidney dysfunction are strong predictors of mortality in patients with low EF. Favorable coronary targets, meticulous operative techniques, and optimal surgical timing before hemodynamic deterioration occurs are essential to minimize the risk of revascularization complications and early postoperative mortality.

KEY WORDS: Coronary disease; Coronary artery bypass; Survival rate

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