What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease with poor left ventricular function (n=30). Intervention: Coronary artery bypass grafting (CABG) vs. Preoperative baseline. Primary outcome: Mean ejection fraction (EF) at 12 months (p=0.004).

What does this research mean for the field?

Coronary artery bypass grafting significantly improves ventricular function, including ejection fraction, performance score, left ventricular end-diastolic pressure, and NYHA classification, in patients with poor left ventricular function. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 17, 2019Open Access

Effect of coronary artery bypass surgery on ventricular functions in patients with poor left ventricular function

Key Result

Coronary artery bypass grafting significantly improved mean ejection fraction from 29.2% preoperatively to 33.8% at 12 months in patients with poor left ventricular function.

Study Design

Type

Observational (n=30)

Multicenter

Structured PICO

Does coronary artery bypass grafting improve ventricular function in patients with coronary artery disease and poor left ventricular function?

Population

30 patients with coronary artery disease and poor ventricular function (EF < 35%, LVEDP > 20 mmHg, Performance score > 15) undergoing coronary artery bypass grafting, mean age 60.1 ± 8 years, 94% male, at a single center in Turkey.

Intervention

Coronary artery bypass grafting (CABG) using mild hypothermia (34°C) and blood cardioplegia.

Outcome

Improvement in ventricular function measured by ejection fraction (EF), left ventricular end-diastolic pressure (LVEDP), performance score (PS), and NYHA classification at 2, 6, and 12 months postoperatively.surrogate

Coronary artery bypass grafting significantly improves global ventricular function, left ventricular end-diastolic pressure, and functional capacity in patients with ischemic heart disease and severe left ventricular dysfunction.

Main Result

Absolute Event Rate: 33.8% vs 29.23%

p-value: p=0.004

Limitations

Retrospective and uncontrolled design (noted in limitations despite abstract stating prospective)
Echocardiograms are not routinely taken after CABG surgery, which may introduce selection bias
Echocardiographic measurements were performed only three times in individual patients
Variability in EF measurement between observers is 6%
Small sample size based on observations of cases

Abstract

Objectives: The aim of the present study was to compare preoperative / postoperative ventricular functions of patients with ventricular dysfunction who were planned for coronary artery bypass grafting (CABG) using echocardiography and angiography, and to evaluate whether there was a significant improvement in ventricular function.Methods: This prospective study included 30 patients with poor ventricular function who had undergone CABG at the Cardiovascular Surgery Clinics of Bursa Yüksek Ihtisas Hospital. The patients' ventricular functions were compared preoperatively and postoperatively at the 2nd, 6th and 12th months.Results: Of the patients, 28 were males, and the mean age was 60.1 ± 8 years (range 39-71). In these cases, functional capacity improved within the early postoperative period, and global ventricular functions improved within the postoperative first year. The improvement in ejection fraction results was statistically significant at 6 months and 12 months (p < 0.05). A significant decrease was observed in left ventricular enddiastolic pressures within one year (p < 0.001). For the performance score, improvement was significant from the 2nd month (p < 0.05). Conclusions: Our findings show that CABG improves ventricular function in terms of EF, PS, LVEDP and NYHA classification. In conclusion, we consider that CABG is a significantly effective option in patients with poor ventricular function.

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