Coronary Bypass Safe in Patients With Low Ejection Fraction

SAN FRANCISCO (Reuters Health) – Patients with coronary artery disease and severely impaired left ventricular ejection fraction can still benefit from coronary artery bypass graft (CABG) surgery, according to researchers from the Veterans Administration Boston Healthcare System.

Dr. Vladimir Birjiniuk told Reuters Health that this finding opens other possibilities for such patients, “especially patients who are deemed too old or have other contraindications to transplantation,” he said. “If you revascularize, all the contraindications are gone and you widen the opportunity for patients to get the benefits from surgery beyond those achieved through medical treatment alone,” he added.

Dr. Birjiniuk and colleagues at the West Roxbury, Massachusetts, facility, collected data on 95 patients with a left ventricular ejection fraction of 25% or less who underwent CABG for coronary artery disease. Among these patients, 63% patients were NYHA Functional Class III or IV, 33% had diabetes, 31% had COPD, 36% had peripheral vascular disease and 21% had cerebrovascular disease.

“Despite the high incidence of adverse risk prognosticators, operative outcomes were favorable: operative mortality was 5.2% and perioperative myocardial infarction occurred in 2.1%,” according to Dr. Birjiniuk’s presentation here Tuesday at the meeting of the American College of Chest Physicians. The report also noted that none of the patients had perioperative stroke or renal failure, and only six patients needed more than 48 hours of ventilator support.

Transplantation has its own indications and not all patients who are candidates for transplantation are candidates for revascularization, Dr. Birjiniuk told Reuters Health. “The number of patients who can benefit from revascularization depends on how aggressive the surgeon is; the more aggressive the surgeon the more patients will benefit,” he said.