Document Detail


Coronary artery bypass grafting with or without surgical ventricular restoration: a comparison.
MedLine Citation:
PMID:  18721565     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Coronary artery bypass grafting (CABG) is an effective treatment for ischemic cardiomyopathy. However, patients with ventricular enlargement are known to have inferior outcomes. We assessed whether surgical ventricular restoration (SVR) with CABG (SVR + CABG) leads to improved outcomes versus CABG alone for patients with ischemic cardiomyopathy and ventricular enlargement. METHODS: We conducted a case-control study comparing patients with ischemic cardiomyopathy and ejection fraction less than 0.35 who underwent SVR + CABG versus CABG alone from June 2002 to December 2005. Patients who underwent SVR + CABG were compared with control patients who met criteria for SVR + CABG by ventriculogram or echocardiogram but received CABG alone. End points included survival, rehospitalization for heart failure, and New York Heart Association class. RESULTS: During the study period 120 patients underwent SVR + CABG (n = 62) versus CABG alone (n = 58). Patients in the SVR + CABG group were younger (60 versus 64 years; p = 0.04) and more likely to be New York Heart Association class III or IV preoperatively (98% versus 86%; p = 0.01). Operative mortality was similar between groups (6.4% versus 5.2%; p = 1.00). Ejection fraction was similar preoperatively (0.22 versus 0.24; p = 0.31) and postoperatively (0.34 versus 00.32; p = 0.40). The SVR + CABG patients experienced fewer rehospitalizations for heart failure (24% [13 of 54] versus 55% [24 of 44]; p = 0.006) but had similar 4-year survival (p = 0.60). At follow-up, 80% (50 of 62) of SVR + CABG versus 57% (27 of 47) of CABG alone patients improved to New York Heart Association class I or II (p = 0.01). CONCLUSIONS: Patients with ischemic cardiomyopathy and ventricular enlargement experience similar early survival after SVR + CABG or CABG alone. However, SVR + CABG resulted in fewer rehospitalizations and better improvements in New York Heart Association class. Surgical ventricular restoration with CABG should be offered to eligible patients with ischemic cardiomyopathy and ventricular enlargement.
Authors:
Roni B Prucz; Eric S Weiss; Nishant D Patel; Lois U Nwakanma; William A Baumgartner; John V Conte
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  86     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-25     Completed Date:  2008-09-19     Revised Date:  2009-07-27    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  806-14; discussion 806-14     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-4618, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Cardiomegaly / surgery
Cardiomyopathies / complications,  surgery
Coronary Artery Bypass / methods*,  mortality
Female
Heart Failure / therapy
Heart Ventricles / surgery*
Hospitalization
Humans
Male
Middle Aged
Retrospective Studies
Stroke Volume
Comments/Corrections
Comment In:
Ann Thorac Surg. 2009 Aug;88(2):708-9; author reply 709   [PMID:  19632459 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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