Results of surgical revascularization in ischaemic heart failure without angina

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Abstract
Seventeen patients with severe ischaemic heart failure without anginawere studied prospectively to determine the effects of surgicalrevascularization on exercise tolerance, peak oxygen consumption and leftventricular function at rest and during inotropic stimulation at 3 monthsafter surgery. Suitability for surgery was assessed by the presence ofischaemia identified by thallium scintigraphy and stresselectrocardiographic (ECG) testing and the left ventricular response todobutamine measured by radionuclide ventriculography. One patient diedawaiting surgery and one required cardiac transplantation. Fifteen patientsunderwent coronary artery surgery with two perioperative deaths. Thirteenpatients were restudied 3 months after surgery. Mean treadmill exercisetime (362 +/- 204 s to 562 +/- 303 s, P < 0.05) and peak oxygenconsumption (14.9 +/- 3.5 ml/kg per min to 20.8 ml/kg per min, P < 0.01)increased significantly. Resting ejection fraction was not changed aftersurgery (20 +/- 5% to 21 +/- 6%) but ejection fraction during derived fromthermodilution Swan-Ganz catheter data both at rest during dobutaminestimulation were unchanged after surgery. At 13 +/- 3 months after surgerythere had been three sudden deaths and one patient had undergone successfulcardiac transplantation. Of the remaining nine patients, three had improvedto NYHA symptomatic class I, three were in NYHA class II and three in NYHAclass III. Repeat treadmill exercise testing in seven patients showed thatthe improvement in exercise capacity evident in the first follow- up visitwas maintained during long-term follow-up.

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