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Thorac Cardiovasc Surg 2022; 70(07): 544-548
DOI: 10.1055/s-0041-1736246
Original Cardiovascular

Ejection Fraction Recovery after Coronary Artery Bypass Grafting for Ischemic Cardiomyopathy

Vasileios Ntinopoulos 
1   Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
,
Nestoras Papadopoulos
1   Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
,
Dragan Odavic
1   Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
,
Achim Haeussler
1   Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
,
Omer Dzemali
1   Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
› Author Affiliations Funding None.
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Abstract

Background Controversy exists about left ventricular systolic function recovery after coronary artery bypass grafting in patients with ischemic cardiomyopathy. The aim of this study is to evaluate the temporal evolvement of left ventricular systolic function after coronary artery bypass surgery in patients with ischemic cardiomyopathy.

Patients and Methods A total of 50 patients with coronary artery disease and left ventricular ejection fraction (LVEF) ≤35% underwent isolated coronary artery bypass grafting in a single center in the period 2017 to 2019. We performed a retrospective analysis of the echocardiographic and clinical follow-up data at 3 months and 1 year postoperatively.

Results Median LVEF preoperatively was 25% (20–33%), mean patient age was 66 ± 8.2 years, 33 (66%) patients were operated off-pump, and 22 (44%) procedures were non-elective. There was no in-hospital myocardial infarction, stroke, and repeat revascularization. Three (6%) patients underwent re-exploration for bleeding or tamponade. In-hospital mortality was 8% and 1-year mortality was 12%. At 1 year postoperatively, there was no repeat revascularization, no myocardial infarction, 1 (2.6%) patient had a transient ischemic attack, and 10 (20%) patients required an implantable defibrillator. There was a statistically significant median ejection fraction increase at 3 months (15% [5–22%], p < 0.0001) and 1 year (23% [13–25%], p < 0.0001) postoperatively, with an absolute increase ≥10% in 32 (74.4%) and 30 (78.9%) patients at 3 months and 1 year, respectively.

Conclusion Patients with ischemic cardiomyopathy undergoing coronary artery bypass surgery show continuous recovery of left ventricular systolic function in the first postoperative year.

Keywords

coronary artery bypass grafting - CABG - off-pump surgery - heart failure

Note

This article has been presented in part at the virtual 50th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery on February 27, 2021.




Publication History

Received: 14 April 2021

Accepted: 20 July 2021

Article published online:
11 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Virani SS, Alonso A, Aparicio HJ. et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 update: a report from the American Heart Association. Circulation 2021; 143 (08) e254-e743
    CrossrefPubMedGoogle Scholar
  • 2 Petrie MC, Jhund PS, She L. et al; STICH Trial Investigators. Ten-year outcomes after coronary artery bypass grafting according to age in patients with heart failure and left ventricular systolic dysfunction: an analysis of the extended follow-up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation 2016; 134 (18) 1314-1324
    CrossrefPubMedGoogle Scholar
  • 3 Sun LY, Gaudino M, Chen RJ, Bader Eddeen A, Ruel M. Long-term outcomes in patients with severely reduced left ventricular ejection fraction undergoing percutaneous coronary intervention vs coronary artery bypass grafting. JAMA Cardiol 2020; 5 (06) 631-641
    CrossrefPubMedGoogle Scholar
  • 4 Jose R, Shetty A, Krishna N. et al. Early and mid-term outcomes of patients undergoing coronary artery bypass grafting in ischemic cardiomyopathy. J Am Heart Assoc 2019; 8 (10) e010225
    CrossrefPubMedGoogle Scholar
  • 5 Lozonschi L, Kohmoto T, Osaki S. et al. Coronary bypass in left ventricular dysfunction and differential cardiac recovery. Asian Cardiovasc Thorac Ann 2017; 25 (09) 586-593
    CrossrefPubMedGoogle Scholar
  • 6 Fukui T, Shibata T, Sasaki Y. et al. Long-term survival and functional recovery after isolated coronary artery bypass grafting in patients with severe left ventricular dysfunction. Gen Thorac Cardiovasc Surg 2007; 55 (10) 403-408
    CrossrefPubMedGoogle Scholar
  • 7 Depré C, Vanoverschelde JL, Gerber B, Borgers M, Melin JA, Dion R. Correlation of functional recovery with myocardial blood flow, glucose uptake, and morphologic features in patients with chronic left ventricular ischemic dysfunction undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 1997; 113 (02) 371-378
    CrossrefPubMedGoogle Scholar
  • 8 Soliman Hamad MA, Peels K, Van Straten A, Van Zundert A, Schönberger J. Coronary artery bypass surgery in patients with impaired left ventricular function. Predictors of hospital outcome. Acta Anaesthesiol Belg 2007; 58 (01) 37-44
    PubMedGoogle Scholar
  • 9 Vanoverschelde JL, Depré C, Gerber BL. et al. Time course of functional recovery after coronary artery bypass graft surgery in patients with chronic left ventricular ischemic dysfunction. Am J Cardiol 2000; 85 (12) 1432-1439
    CrossrefPubMedGoogle Scholar
  • 10 Lorusso R, La Canna G, Ceconi C. et al. Long-term results of coronary artery bypass grafting procedure in the presence of left ventricular dysfunction and hibernating myocardium. Eur J Cardiothorac Surg 2001; 20 (05) 937-948
    CrossrefPubMedGoogle Scholar
  • 11 Roberts AJ, Spies SM, Meyers SN. et al. Early and long-term improvement in left ventricular performance following coronary bypass surgery. Surgery 1980; 88 (04) 467-475
    PubMedGoogle Scholar
  • 12 Haxhibeqiri-Karabdic I, Hasanovic A, Kabil E, Straus S. Improvement of ejection fraction after coronary artery bypass grafting surgery in patients with impaired left ventricular function. Med Arh 2014; 68 (05) 332-334
    CrossrefPubMedGoogle Scholar
  • 13 Yee NP, Siu AM, Davis J, Kao J. Recovery of left ventricular function after percutaneous coronary intervention compared to coronary artery bypass grafting in patients with multi-vessel coronary disease and left ventricular dysfunction. Hawaii J Med Public Health 2016; 75 (09) 273-277
    PubMedGoogle Scholar
  • 14 Shikata F, Imagawa H, Kawachi K. et al. Regional myocardial blood flow measured by stress multidetector computed tomography as a predictor of recovery of left ventricular function after coronary artery bypass grafting. Am Heart J 2010; 160 (03) 528-534
    CrossrefPubMedGoogle Scholar
  • 15 Pasquet A, Lauer MS, Williams MJ, Secknus MA, Lytle B, Marwick TH. Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction. Impact of pre-operative myocardial function, perfusion, and metabolism. Eur Heart J 2000; 21 (02) 125-136
    CrossrefPubMedGoogle Scholar
  • 16 Flameng WJ, Shivalkar B, Spiessens B. et al. PET scan predicts recovery of left ventricular function after coronary artery bypass operation. Ann Thorac Surg 1997; 64 (06) 1694-1701
    CrossrefPubMedGoogle Scholar
  • 17 Hausmann H, Meyer R, Siniawski H. et al. Factors exercising an influence on recovery of hibernating myocardium after coronary artery bypass grafting. Eur J Cardiothorac Surg 2004; 26 (01) 89-95
    CrossrefPubMedGoogle Scholar
  • 18 Hwang HY, Yeom SY, Park E-A, Lee W, Jang M-J, Kim K-B. Serial cardiac magnetic resonance imaging after surgical coronary revascularization for left ventricular dysfunction. J Thorac Cardiovasc Surg 2020; 159 (05) 1798-1805
    CrossrefPubMedGoogle Scholar
  • 19 Paeng JC, Lee DS, Kang WJ. et al. Time course of functional recovery after coronary artery bypass grafting surgery according to the preoperative reversibility of perfusion impairment on myocardial SPECT. Eur J Nucl Med Mol Imaging 2005; 32 (01) 70-74
    CrossrefPubMedGoogle Scholar
  • 20 deFilippi CR, Willett DL, Irani WN, Eichhorn EJ, Velasco CE, Grayburn PA. Comparison of myocardial contrast echocardiography and low-dose dobutamine stress echocardiography in predicting recovery of left ventricular function after coronary revascularization in chronic ischemic heart disease. Circulation 1995; 92 (10) 2863-2868
    CrossrefPubMedGoogle Scholar
  • 21 Mandegar MH, Yousefnia MA, Roshanali F, Rayatzadeh H, Alaeddini F. Interaction between two predictors of functional outcome after revascularization in ischemic cardiomyopathy: left ventricular volume and amount of viable myocardium. J Thorac Cardiovasc Surg 2008; 136 (04) 930-936
    CrossrefPubMedGoogle Scholar
  • 22 Normand C, Linde C, Singh J, Dickstein K. Indications for cardiac resynchronization therapy: a comparison of the major international guidelines. JACC Heart Fail 2018; 6 (04) 308-316
    CrossrefPubMedGoogle Scholar