Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy

Giovanni Battista Luciani, Giuseppe Montalbano, Gianluca Casali, Alessandro Mazzucco

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Objective: The goal of the present study was to define the early and late functional results after revascularization in ischemic cardiomyopathy and to identify variables predictive of a favorable outcome. Methods: A retrospective review of all consecutive patients with ischemic cardiomyopathy undergoing myocardial revascularization between January 1991 and June 1998 was undertaken. One hundred sixty-seven patients (140 men) aged 60 ± 8 years (range, 39-77 years) with angina (n = 107), congestive heart failure (n = 54), or silent ischemia (n = 6) were identified. One hundred six (63%) patients with angina were in Canadian Cardiovascular Society class III or IV, and 40 (24%) patients with congestive failure were in New York Heart Association class III or IV. The preoperative left ventricular ejection fraction averaged 0.28 ± 0.05 (range, 0.16-0.30). Thirteen (8%) patients required preoperative mechanical life support. A mean of 2.9 ± 0.9 grafts per patient were performed, with an average myocardial ischemia time of 53 ± 23 minutes and bypass time of 104 ± 31 minutes. Results: There were 3 (1.7%) early deaths and 21 (13%) deaths during follow-up (2.7 ± 2.1 years; range, 0.3-7.8 years), producing a survival of 94% ± 2% and 75% ± 10% at 1 and 5 years, respectively. Despite a significant increase in left ventricular ejection fraction (0.28 ± 0.05 vs 0.38 ± 0.09, P = .0001), only 89 (54%) patients were symptom-free at follow-up. Freedom from recurrent angina was 98% ± 1% and 81% ± 8%, whereas freedom from congestive failure was 78% ± 11% and 47% ± 20% at 1 and 5 years, respectively. Follow-up New York Heart Association class in patients with congestive failure was improved (40/54 class III-IV vs 11/54 class III-IV, P = .0001). Multivariate analysis showed a lower ejection fraction (P = .01), pre-operative congestive failure (P = .03), and a need for preoperative intra-aortic balloon pumping (P = .03) to be associated with a greater prevalence of recurrent congestive failure, whereas male sex (P = .01), preoperative angina (P = .04), use of the internal thoracic artery (P = .03), and higher number of grafts (P = .01) were associated with lower prevalence. Male sex (P = .06), higher number of grafts (P = .04), and shorter duration of myocardial ischemia (P = .04) were also predictive of improvement in New York Heart Association class at follow-up. Conclusions: Despite satisfactory early and late survival, late functional out-come after myocardial revascularization in ischemic cardiomyopathy remains suboptimal because of recurrence or persistence of congestive failure. Selection of appropriate surgical candidates and extensive use of complete revascularization with the internal thoracic artery may substantially improve functional results.

Original languageEnglish
Pages (from-to)478-489
Number of pages12
JournalJournal of Thoracic and Cardiovascular Surgery
Volume120
Issue number3
Publication statusPublished - 2000

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Myocardial Revascularization
Cardiomyopathies
Mammary Arteries
Transplants
Stroke Volume
Myocardial Ischemia
Intra-Aortic Balloon Pumping
Survival
Multivariate Analysis
Ischemia
Heart Failure
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy. / Luciani, Giovanni Battista; Montalbano, Giuseppe; Casali, Gianluca; Mazzucco, Alessandro.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 120, No. 3, 2000, p. 478-489.

Research output: Contribution to journalArticle

Luciani, Giovanni Battista ; Montalbano, Giuseppe ; Casali, Gianluca ; Mazzucco, Alessandro. / Predicting long-term functional results after myocardial revascularization in ischemic cardiomyopathy. In: Journal of Thoracic and Cardiovascular Surgery. 2000 ; Vol. 120, No. 3. pp. 478-489.
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AU - Luciani, Giovanni Battista

AU - Montalbano, Giuseppe

AU - Casali, Gianluca

AU - Mazzucco, Alessandro

PY - 2000

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N2 - Objective: The goal of the present study was to define the early and late functional results after revascularization in ischemic cardiomyopathy and to identify variables predictive of a favorable outcome. Methods: A retrospective review of all consecutive patients with ischemic cardiomyopathy undergoing myocardial revascularization between January 1991 and June 1998 was undertaken. One hundred sixty-seven patients (140 men) aged 60 ± 8 years (range, 39-77 years) with angina (n = 107), congestive heart failure (n = 54), or silent ischemia (n = 6) were identified. One hundred six (63%) patients with angina were in Canadian Cardiovascular Society class III or IV, and 40 (24%) patients with congestive failure were in New York Heart Association class III or IV. The preoperative left ventricular ejection fraction averaged 0.28 ± 0.05 (range, 0.16-0.30). Thirteen (8%) patients required preoperative mechanical life support. A mean of 2.9 ± 0.9 grafts per patient were performed, with an average myocardial ischemia time of 53 ± 23 minutes and bypass time of 104 ± 31 minutes. Results: There were 3 (1.7%) early deaths and 21 (13%) deaths during follow-up (2.7 ± 2.1 years; range, 0.3-7.8 years), producing a survival of 94% ± 2% and 75% ± 10% at 1 and 5 years, respectively. Despite a significant increase in left ventricular ejection fraction (0.28 ± 0.05 vs 0.38 ± 0.09, P = .0001), only 89 (54%) patients were symptom-free at follow-up. Freedom from recurrent angina was 98% ± 1% and 81% ± 8%, whereas freedom from congestive failure was 78% ± 11% and 47% ± 20% at 1 and 5 years, respectively. Follow-up New York Heart Association class in patients with congestive failure was improved (40/54 class III-IV vs 11/54 class III-IV, P = .0001). Multivariate analysis showed a lower ejection fraction (P = .01), pre-operative congestive failure (P = .03), and a need for preoperative intra-aortic balloon pumping (P = .03) to be associated with a greater prevalence of recurrent congestive failure, whereas male sex (P = .01), preoperative angina (P = .04), use of the internal thoracic artery (P = .03), and higher number of grafts (P = .01) were associated with lower prevalence. Male sex (P = .06), higher number of grafts (P = .04), and shorter duration of myocardial ischemia (P = .04) were also predictive of improvement in New York Heart Association class at follow-up. Conclusions: Despite satisfactory early and late survival, late functional out-come after myocardial revascularization in ischemic cardiomyopathy remains suboptimal because of recurrence or persistence of congestive failure. Selection of appropriate surgical candidates and extensive use of complete revascularization with the internal thoracic artery may substantially improve functional results.

AB - Objective: The goal of the present study was to define the early and late functional results after revascularization in ischemic cardiomyopathy and to identify variables predictive of a favorable outcome. Methods: A retrospective review of all consecutive patients with ischemic cardiomyopathy undergoing myocardial revascularization between January 1991 and June 1998 was undertaken. One hundred sixty-seven patients (140 men) aged 60 ± 8 years (range, 39-77 years) with angina (n = 107), congestive heart failure (n = 54), or silent ischemia (n = 6) were identified. One hundred six (63%) patients with angina were in Canadian Cardiovascular Society class III or IV, and 40 (24%) patients with congestive failure were in New York Heart Association class III or IV. The preoperative left ventricular ejection fraction averaged 0.28 ± 0.05 (range, 0.16-0.30). Thirteen (8%) patients required preoperative mechanical life support. A mean of 2.9 ± 0.9 grafts per patient were performed, with an average myocardial ischemia time of 53 ± 23 minutes and bypass time of 104 ± 31 minutes. Results: There were 3 (1.7%) early deaths and 21 (13%) deaths during follow-up (2.7 ± 2.1 years; range, 0.3-7.8 years), producing a survival of 94% ± 2% and 75% ± 10% at 1 and 5 years, respectively. Despite a significant increase in left ventricular ejection fraction (0.28 ± 0.05 vs 0.38 ± 0.09, P = .0001), only 89 (54%) patients were symptom-free at follow-up. Freedom from recurrent angina was 98% ± 1% and 81% ± 8%, whereas freedom from congestive failure was 78% ± 11% and 47% ± 20% at 1 and 5 years, respectively. Follow-up New York Heart Association class in patients with congestive failure was improved (40/54 class III-IV vs 11/54 class III-IV, P = .0001). Multivariate analysis showed a lower ejection fraction (P = .01), pre-operative congestive failure (P = .03), and a need for preoperative intra-aortic balloon pumping (P = .03) to be associated with a greater prevalence of recurrent congestive failure, whereas male sex (P = .01), preoperative angina (P = .04), use of the internal thoracic artery (P = .03), and higher number of grafts (P = .01) were associated with lower prevalence. Male sex (P = .06), higher number of grafts (P = .04), and shorter duration of myocardial ischemia (P = .04) were also predictive of improvement in New York Heart Association class at follow-up. Conclusions: Despite satisfactory early and late survival, late functional out-come after myocardial revascularization in ischemic cardiomyopathy remains suboptimal because of recurrence or persistence of congestive failure. Selection of appropriate surgical candidates and extensive use of complete revascularization with the internal thoracic artery may substantially improve functional results.

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