The Journal of Thoracic and Cardiovascular Surgery, Vol 69, 52-62, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Myocardial revascularization in patients with poor ventricular function
BF Mitchel Jr, PA Alivizatos, M Adam, GF Geisler, JP Thiele and CJ Lambert
Eighty patients with evidence of impaired ventricular function by
ventriculography were reviewed. On the basis of the ejection fraction,
these patients were divided into three groups. Those with ejection
fractions less than 0.2 were considered in very poor condition, those with
ejection fractions of 0.2 to 0.4 were considered in poor condition, and
those with ejection fractions with between 0.4 and 0.6 were considered
fair. Suitability of vessels for bypassing and the presence or absence of
collateral cirulation on the cinearteriograms was also noted for possible
influence on result. Operative mortality rate in patients having complete
repair, defined as bypassing all major vessels with significant
obstruction, was 7 per cent. In 26 patients having incomplete repair, the
operative mortality was 30 per cent. However, the late mortality rate was
not favorably influenced by complete repair, 75 per cent are in improved or
good clinical condition, as compared with 65 per cent in the incomplete
repair group. As patients with impairment of ventricular contractility are
at high risk, it is believed that they should continue to be evaluated on
an individual basis for bypass surgery and not categorically denied
treatment.
