Key result
Reoperative CABG in patients with LVEF ≤25% was associated with higher postoperative mortality compared to primary CABG (23.5% vs 12.1%, P<0.05).
Why the study?
Does reoperative CABG compared to primary CABG affect postoperative mortality and functional outcomes in patients with LVEF ≤ 25%?
Cohort (n=108)
Does reoperative CABG compared to primary CABG affect postoperative mortality and functional outcomes in patients with LVEF ≤ 25%?
Absolute Event Rate: 23.5% vs 12.1%
p-value: p=< 0.05
Although reoperative CABG in patients with LVEF ≤ 25% carries a higher operative mortality than primary CABG, it provides significant improvements in functional status and LVEF, indicating it remains a viable option for carefully selected patients.
Reoperative CABG linked to higher mortality in LVEF ≤25% warrants caution in selection; leaves open net benefit versus primary procedures in observational data.
AIM: This study aimed to investigate whether patients with very low left ventricular ejection fractions (LVEF) should be accepted for reoperative coronary artery bypass grafting (CABG). STUDY POPULATION: Between January 1990 and December 1993, 1681 patients underwent primary CABG and 308 (15.5%) reoperative CABG. One hundred and eight patients (5.4%) had an LVEF < or = 25%, 91 patients for primary CAGB (group I) and 17 for CABG (group II). The mean age of the patients was 62 years. Sex distribution and preoperative risk factors did not differ. Urgent operations were more frequently necessary in group II (P < 0.01). Mitral regurgitation was present in 49% of the group I patients and 18% of the group II patients (P < 0.05). Pulmonary artery hypertension was observed in 24% of group I patients, but in only 6% in group II patients. The mean LVEF was 21% and left ventricular end-diastolic pressure 18 mmHg, without between-group differences. All patients had significant two- or three-vessel disease (stenosis > or = 70%). An average of 4.5 grafts per patient were performed. Mitral valve surgery was not performed in any of the patients. RESULTS: The postoperative mortality was significantly higher in reoperative CABG patients (group II; 23.5%) than in group I patients (12.1%; P < 0.05), whereas the incidence of non-fatal myocardial infarction did not differ. The incidence of postoperative complications did not differ between the groups, except for transient renal failure, more frequently encountered in group II (P < 0.05). After an average follow-up of 18 months, the New York Heart Association (NYHA) class and the LVEF were significantly improved in both groups (NYHA class from 3.5 to 1.8 and LVEF from 21% to 45%; P < 0.001). The mitral regurgitation had improved or completely disappeared at the end of follow-up in all patients in both groups. CONCLUSIONS: Our results suggest that patients with left ventricular ejection fraction < or = 25%, angina and significant two- or three-vessel coronary artery disease should not categorically be refused for reoperative CABG. Careful patient selection is necessary because of an increased operative risk.
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Christenson et al. (1995) conducted a cohort in Coronary artery disease with LVEF ≤25% (n=108). Reoperative CABG vs. Primary CABG was evaluated on Postoperative mortality (p=< 0.05). Reoperative CABG in patients with LVEF ≤25% was associated with higher postoperative mortality compared to primary CABG (23.5% vs 12.1%, P<0.05).
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