Myocardial revascularization for severe left ventricular dysfunction. Factors influencing early and late survival

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Abstract
The results of coronary bypass surgery have been assessed in 102 patients with severe left ventricular dysfunction who had a preoperative left ventricular ejection fraction of ⩽0.35 (mean(s.e.m.) 0.29 (0.01)). Independent risk factors influencing operative mortality were obesity (P = 0.0290) and the need for preoperative intra-aortic balloon counterpulsation (P = 0.0010). Cox regression analysis using as its end-point ‘cardiac-related death’ demonstrated three variables; the need for preoperative intra-aortic balloon counterpulsation (P = 0.001), advanced age (P = 0.011), and obesity (P = 0.036). In a subset of 43 patients who did not have these risk factors, the 4-year cardiac-related death rate was 95.1 (3.4)%. The operative mortality and long-term survival can be expected to be satisfactory in patients with severe left ventricular dysfunction, provided they have a viable myocardium rather than myocardial fibrosis.

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