Davoodi Saeed, Sheikhvatan Mehrdad, Karimi Abbasali, Ahmadi Seyed Hossein, Goodarzynejad Hamidreza, Fathollahi Mahmood Sheikh
Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran 1411713138, Iran.
Gen Thorac Cardiovasc Surg. 2012 Apr;60(4):202-12. doi: 10.1007/s11748-010-0918-y. Epub 2012 Mar 28.
The aim of this study was to identify determinants of long-term results after coronary artery bypass surgery (CABG) in group of Iranian patients with systolic left ventricular (LV) dysfunction.
Reduced LV function was defined as an LV ejection fraction of <30%. Using our surgery database, we randomly selected 110 patients with EF < 30% and the same number of patients with EF ≥ 30% for whom demographic and clinical characteristics as well as in-hospital postoperative outcomes were available. Followup data were completed for 94 patients with EF < 30% (85.5%) and 101 patients with EF ≥ 30% (91.8%). Longterm results of the operation and the patients' quality of life were assessed for a mean follow-up period of 29.4 ± 11.0 months.
In-hospital mortality and follow-up survival rates had no statistically differences in the low and normal EF groups (2.2% vs. 1.1% and 86.0% vs. 93.6%, respectively). Long-term surgical morbidity occurred in 43.6% of patients with severe LV dysfunction and in 38.6% of normal EF patients; it was considered similar for the two groups. Family history of coronary artery disease, New York Heart Association class IV, and moderate mitral insufficiency were the main predictors of long-term morbidity. Regarding the quality-of-life assessment, patients with severe LV dysfunction attained significantly lower levels of social activities.
Patients with severe LV dysfunction in comparison with those with normal LV function had similar 3-year survival rates and long-term complications. To improve survival following CABG in patients with severe LV dysfunction, mitral valve repair/replacement at the time of the initial operation should be considered.
本研究旨在确定伊朗收缩性左心室（LV）功能不全患者冠状动脉旁路移植术（CABG）后长期疗效的决定因素。
左心室功能降低定义为左心室射血分数<30%。利用我们的手术数据库，我们随机选择了110例射血分数<30%的患者和相同数量射血分数≥30%的患者，这些患者的人口统计学和临床特征以及术后住院结局数据均可用。94例射血分数<30%的患者（85.5%）和101例射血分数≥30%的患者（91.8%）完成了随访数据。对手术的长期疗效和患者的生活质量进行了评估，平均随访期为29.4±11.0个月。
低射血分数组和正常射血分数组的住院死亡率和随访生存率无统计学差异（分别为2.2%对1.1%和86.0%对93.6%）。43.6%的严重左心室功能不全患者和38.6%的正常射血分数患者发生了长期手术并发症；两组被认为相似。冠心病家族史、纽约心脏协会IV级和中度二尖瓣关闭不全是长期并发症的主要预测因素。关于生活质量评估，严重左心室功能不全的患者社交活动水平明显较低。
与左心室功能正常的患者相比，严重左心室功能不全的患者3年生存率和长期并发症相似。为提高严重左心室功能不全患者冠状动脉旁路移植术后的生存率，应考虑在初次手术时进行二尖瓣修复/置换。
