doiSerbia

Surgical revascularisation of the heart in patients with chronic ischaemic cardiomyopathy and left ventricular ejection fraction of less than 30%

Velinović Miloš (Klinika za kardiohirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Kočica Mladen (Klinika za kardiohirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Vraneš Mile (Klinika za kardiohirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Đukić Petar (Klinika za kardiohirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Mikić Aleksandar (Klinika za kardiohirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Vukomanović Vlada (Kardiološko odeljenje, Institut za zdravstvenu zaštitu majke i deteta Srbije 'Dr Vukan Čupić', Beograd)
Davidović Lazar (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Obrenović-Kirćanski Biljana (Klinika za kardiologiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Cvetković Slobodan (Klinika za vaskularnu hirurgiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Šoškić Ljiljana (Odeljenje anestezije i intenzivne terapije, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)
Ristić Arsen D. (Klinika za kardiologiju, Institut za kardiovaskularne bolesti, Klinički centar Srbije, Beograd)

INTRODUCTION Patients suffering from chronic ischaemic cardiomyopathy and left ventricular ejection fraction (LVEF) lower than 30% represent a difficult and controversial population for surgical treatment. OBJECTIVE The aim of this study was to evaluate the effects of surgical treatment on the early and long-term outcome of these patients. METHOD The patient population comprised SO patients with LVEF< 30% (78% male, mean age: 583 years, range; 42-75 years) who underwent surgical myocardial revascuiarisation during the period 1995-2000. Patients with left ventricular aneurysms or mitral valve insufficiency were excluded from the study. The following echocardiography parameters were evaluated as possible prognostic indicators; LVEF, fraction of shortening (FS), left ventricular systolic and diastolic diameters (LVEDD, LVESD) and volumes (LVEDV, LVESV), as well as their indexed values (LVESVI). RESULTS Fifteen patients (30%) died during the follow-up, 2/50 intraoperatively (4%). The presence of diabetes mellitus, previous myocardial infarction, main left coronary artery disease, and three-vessel disease, correlated significantly with the surgical outcomes. The patient's age, family history, smoking habits, hypertension, hyperlipidaemia, history of stroke, peripheral vascular disease, and renal failure, did not correlate with the mortality rate. A comparison of preoperative echocardiography parameters between survivors and non-survivors revealed significantly divergent LVEF, LVEDD, LVESD, LVEDV, LVESV, and LVESVI values. Preoperative LVESVi offered the highest predictive value (R=0.595). CONCLUSION Diabetes mellitus, history of myocardial infarction, stenosis of the main branch, and three-vessel disease, significantly affected the peci opera five and long-term outcome of surgical revascuiarisation in patients with ischaemic cardiomyopathy and LVEF<30%. in survivors, LVEF, FS, and systolic and diastolic echocardiography parameters, as well as their indexed values, significantly improved after surgical revascuiarisation. LVESVI provided the highest predictive value for mortality.

Keywords: angina pectoris, ejection fraction, left ventricular dysfunction