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The Journal of Thoracic and Cardiovascular Surgery, Vol 74, 77-82, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SL Faulkner, WS Stoney, WC Alford, CS Thomas, GR Burrus, RA Frist and HL Page
The natural history of patients with ischemic heart disease and depressed
left ventricular function is dismal, and medical therapy has failed to
alter its course. To assess the results of aorta-coronary bypass grafting
in patients with coronary artery disease and decreased left ventricular
ejection fraction (LVEF less than or equal to 0.3), we compared 70
medically treated patients to 46 patients having aorta- coronary bypass
grafting. The duration of follow-up was 6 to 72 months (mean 19 months).
All patients had angina pectoris. Congestive heart failure was present in
56 percent (39/70) of the medical and 43 percent (20/46) of the surgical
group. The medical group had a mean LVEF of 0.20 and a mean left
ventricular end-diastolic pressure (LVEDP) of 29 mm. Hg. The surgical group
had a mean LVEF of 0.21 and a mean LVEDP of 24 mm. Hg. Three vessel disease
was found in 60 percent (42/70) of the medical group and 83 percent (38/46)
of the surgical group. The operative mortality rate in the surgical group
was 4 percent (2/46). There were four late deaths. The 2 year actuarial
survival rate for medical and surgical groups was 47 percent and 83
percent, respectively. Significant improvement in angina pectoris and/or
congestive heart failure was found in 16 percent (11/70) of medically
treated patients and 95 percent (38/40) of the surgically treated patients.
Aorta-coronary bypass grafting can be performed in patients with poor left
ventricular function with a low operative mortality rate, relief of angina
pectoris, and improvement in symptoms of congestive heart failure.
ARTICLES
Ischemic cardiomyopathy: medical versus surgical treatment
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