Document Detail

Coronary surgery can be an alternative to heart transplantation in selected patients with end-stage ischemic heart disease.
MedLine Citation:
PMID:  8217227     Owner:  NLM     Status:  MEDLINE    
Patients with ischemic heart disease (IHD) low ejection fraction (EF), and congestive heart failure (CHF), are usually referred for orthotopic heart transplantation (OHT). This study reports our experience with coronary artery bypass grafting (CABG) in patients initially referred for OHT, and suggests guidelines to facilitate the choice of procedure (OHT or CABG). Between January 1990 and December 1991, 32 patients with IHD, proposed for OHT, underwent CABG 31/32 patients were male, the mean age was 58 +/- 12 years (40 to 70). Congestive heart failure was present in all patients and was the main symptom. The mean EF was 23 (14 to 31%), mean cardiac index (CI) 2.4 l/min per m2 (1.6 to 3.1 l/min per m2), mean pulmonary artery mean pressure (MPAP) 26 (20 to 37 mmHg) and mean pulmonary wedge pressure 16 (12 to 22 mmHg). Every patients underwent a myocardial viability study by thallium scintigraphy (n = 32) and/or by positron emission tomography (n = 10). The perioperative mortality was 9.3% (3/32). All long-term survivors (n = 27) are in NYHA Class II with a complete follow-up (mean 18 +/- 6 months). Ejection fraction control either by angiography (n = 15) or by single photon emission computed tomography (n = 12) showed an increase of up to 38% (22%-46%). Three determinant factors influenced the choice of CABG. 1) CI > 21/min per m2, 2) MPAP < 35 mmHg. 3) Detection of myocardial viability.(ABSTRACT TRUNCATED AT 250 WORDS)
G Dreyfus; D Duboc; A Blasco; C Dubois; D Brodaty; D Chatel; P H De Lentdecker; J Bachet; B Goudot; A Piquois
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  7     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  1993  
Date Detail:
Created Date:  1993-12-08     Completed Date:  1993-12-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  482-7; discussion 488     Citation Subset:  IM    
Department of Cardio-vascular Surgery, Hôpital Foch, Suresnes, France.
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MeSH Terms
Coronary Artery Bypass*
Coronary Disease / mortality,  physiopathology,  surgery*
Energy Metabolism / physiology
Follow-Up Studies
Heart Failure / mortality,  physiopathology,  surgery*
Heart Transplantation* / physiology
Hemodynamics / physiology
Hospital Mortality
Middle Aged
Myocardial Contraction / physiology
Myocardial Ischemia / mortality,  physiopathology,  surgery*
Myocardium / metabolism
Postoperative Complications / mortality,  physiopathology
Survival Rate
Tomography, Emission-Computed
Tomography, Emission-Computed, Single-Photon

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