Long-term outcomes after coronary artery bypass graft with or without surgical ventricular reconstruction in patients with severe left ventricular dysfunction

Abstract

Background: Patients with chronic myocardial infarction (MI) and severe left ventricular (LV) dysfunction have poor clinical outcomes. This study aimed to determine whether coronary artery bypass graft (CABG) with surgical ventricular reconstruction (SVR) leads to further improvement in long-term patient outcomes compared with isolated CABG (I-CABG).

Methods: From April 2010 to June 2013, 140 consecutive patients with chronic MI and severe LV dysfunction who received contrast-enhanced cardiovascular magnetic resonance imaging (CE-CMR) within 1 month before surgery were enrolled in this study. The cardiovascular events (CVEs) and long-term survival of patients who underwent CABG and SVR were compared with those who met the criteria for SVR but received I-CABG.

Results: A total of 140 patients were included in the final analysis, including 70 patients who underwent CABG and SVR and 70 patients who underwent I-CABG. No differences were observed in the baseline characteristics, LV function, and late gadolinium enhancement (LGE) between the two groups. CABG+SVR patients experienced a longer cardiopulmonary bypass (CPB) time (116.0±35.0 vs. 100.2±23.8 minutes, P=0.002) and ventilation time [median (interquartile range): 22.0 (17.0, 37.0) vs. 20.0 (15.0, 24.0) hours, P=0.019] than I-CABG patients. During a mean follow-up of 123.1±12.7 months (range, 102-140 months), the CABG+SVR group had fewer rehospitalizations for congestive heart failure (CHF) (4.3% vs. 19.1%, P=0.007), but no statistical difference in the mortality rate was observed (2.9% vs. 4.4%, P=0.987). The cumulative CVE-free survival rate was significantly higher in CABG+SVR patients (87.0% vs. 67.6%, P=0.007).

Conclusions: Our findings indicated that patients with chronic MI and severe LV dysfunction experienced similar perioperative outcomes after CABG+SVR or I-CABG. However, the CABG+SVR group resulted in fewer rehospitalizations for CHF and a higher cumulative CVE-free survival rate.

Keywords: Coronary artery bypass graft (CABG); contrast-enhanced cardiovascular magnetic resonance imaging (CE-CMR); left ventricular aneurysm; surgical ventricular reconstruction (SVR).

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1214/coif). The authors have no conflicts of interest to declare.

2023 Journal of Thoracic Disease. All rights reserved.

Figures

Video 1

Coronary artery bypass graft plus surgical ventricular reconstruction for a patient with chronic myocardial infarction and severe left ventricular dysfunction. This patient was a 64-year-old man with six scar segments on CE-CMR and a left ventricular ejection fraction of 28.1%. The patient underwent coronary artery bypass graft plus surgical ventricular reconstruction and survived without cardiovascular events during the follow-up. CE-CMR, contrast-enhanced cardiovascular magnetic resonance imaging.

Figure 1

Flow diagram illustrating the study design and patient categorization. A total of 140 patients were finally enrolled and analyzed; 70 subjects underwent I-CABG and 70 subjects received CABG and SVR. CABG, coronary artery bypass graft; I-CABG, isolated coronary artery bypass graft; LVEF, left ventricular ejection fraction; SVR, surgical ventricular reconstruction.

Figure 2

Changes in the LVEF and LVEDD by echocardiography. (A) LVEF improved significantly from baseline to 6 months after surgery (P

Figure 3

NYHA heart failure symptoms and CCS angina class at baseline and follow-up. (A) Patents with NYHA class III–IV were distributed similarly between the two groups at baseline. The NYHA class also improved by an average of 1.0 class at follow-up for both groups (P

Figure 4

Survival curves of patients who underwent I-CABG vs. CABG+SVR. (A) Kaplan-Meier curve shows that the rate of survival without CVEs in patients who underwent CABG and SVR was significantly higher than that for patients who underwent I-CABG (87.0% vs. 67.6%, P=0.007, respectively). (B) During a follow-up period of 123.1±12.7 months, the cumulative rate of survival without CVEs for all patients was 77.4%. CABG, coronary artery bypass graft; CVEs, cardiovascular events; I-CABG, isolated coronary artery bypass graft; SVR, surgical ventricular reconstruction.