Results and predictors of early and late outcome of coronary artery bypass grafting in patients with severely depressed left ventricular function

Background. Coronary artery bypass grafting ( CABG) is a well- accepted therapeutic approach in patients with symptomatic multivessel coronary artery disease and severely depressed left ventricular function. However, the potential impact of off- pump CABG in this group of patients remains unknown. In addition, there are only scarce data regarding long- term survival and its predictors in this patient population. Methods. We retrospectively analyzed prospectively collected data of 2,725 consecutive patients ( mean age, 65 +/- 11 years; 843 ( 31%) female) undergoing CABG between January 1998 and December 2005 ( ejection fraction [ EF] <= 0.30; n = 495, 18%). Outcome measures included hospital mortality, major complications, and long- term survival. Multivariate analysis was performed to identify predictors of hospital mortality and late survival. Subgroup analysis for patients with EF less than or equal to 0.30 undergoing conventional CABG ( n = 424, 86%) versus off- pump CABG ( n = 71, 14%) was performed. Results. Hospital mortality was 1.8% ( EF <= 0.30, 3.6%; EF > 0.30, 1.4%; p = 0.002). Off- pump CABG did not have an impact on operative mortality ( on- pump, 4%; off-pump, 3%; p = 0.509). Ejection fraction of 0.30 or less was not an independent risk factor of hospital mortality but predicted respiratory failure ( odds ratio [ OR] = 2.3) and sepsis ( OR, 1.4). Long- term survival was significantly decreased in patients with EF of 0.30 or less: 1- year and 5- year survival 88% +/- 1.5% and 75% +/- 2.2% versus 96% +/- 0.4% and 81% +/- 1.2%, respectively ( p = 0.001). Reoperation ( OR, 6.9), peripheral vascular disease ( OR, 3.2), chronic obstructive pulmonary disease ( OR, 3.0), congestive heart failure ( OR, 2.7), and female sex ( OR, 2.1) were independent predictors of long- term survival. Conclusions. Excellent results after CABG can be expected in patients with EF of 0.30 or less, with minimal increase in mortality and acceptable postoperative morbidity. Long- term survival remains limited, but recent results are substantially better than historical reports. Careful preoperative patient selection and perioperative management are essential in these patients undergoing CABG.