The Journal of Thoracic and Cardiovascular Surgery, Vol 72, 73-79, Copyright © 1976 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Left ventricular function and coronary obstruction as predictors of survival following aorta-coronary bypass
JF Brymer, H Hannah 3d, DM Pugh, M Dunn and RL Reis
A retrospective analysis was undertaken of clinical data and
catheterization studies of 151 consecutive unselected patients who
underwent aorta-coronary bypass at the University of Kansas Medical Center
between 1971 and 1973. The purpose was to determine the effect of
preoperative left ventricular function and extent and severity of coronary
artery obstruction on operative mortality rate and long-term survival. The
postoperative follow-up period ranged from 10 to 49 months and averaged 26
months. Left ventricular function was assessed by qualitative analysis of
left ventricular angiograms. Severity of coronary obstruction was
quantified by scoring coronary arteriograms according to the system of
Friesinger and associates. Patients with normal or near normal
ventriculograms were considered to have good left ventricular function.
Patients showing moderate or severe impairment of contraction were
considered to have poor left ventricular function. Obstruction scores
ranging from 2 to 7 points were classified as low scores, and scores from 8
to 15 points were classified as high scores. Four groups of patients were
identified based upon preoperative left ventricular function and
obstruction severity: Group I, 29 patients with good left ventricular
function and low scores; Group II, 22 patients with poor left ventricular
function and low scores. Group III, 28 patients with good left ventricular
function and high scores. Elective aorta-coronary bypass in these three
groups was accompanied by no operative or late deaths. Group IV comprised
72 patients with poor left ventricular function and high scores. In this
group there was a 10 per cent operative mortality rate (7 of 72 patients)
and a 5 per cent year late mortality rate. Relief of angina occurred
equally in all groups. Thus operative risk can be prospectively determined
by analysis of left ventricular function and severity of coronary
obstruction. Surgical treatment resulted in negligible operative and late
mortality rates (0 per cent) in all patients except those in whom poor
ventricular function was accompanied by severe and diffuse coronary artery
obstruction. Operation should be offered to this latter group (Group IV)
despite the higher operative and postoperative risk because of salutary
postoperative results.
