Risk and benefit of additional aortocoronary bypass grafting in patients undergoing cardioverter-defibrillator implantation.

It is unclear whether additional aortocoronary bypass grafting should be performed in patients who need an automatic implantable cardioverter defibrillator (ICD) in one- or two-step procedures. Therefore we studied the follow-up of 139 patients who underwent epicardial implantation of the cardioverter defibrillator (CD). All patients had coronary artery disease and recurrent ventricular tachycardia or fibrillation. Eighty-nine patients had implantation of the CD without additional surgical approaches (group G1), and 50 patients had concomitant aortocoronary bypass grafting (group G2). Perioperative mortality (within 30 days after CD implant) was 1 (1%) of 89 patients in G1 and 6 (12%) of 50 patients in G2 (p < 0.01). During the mean follow-up of 26 +/- 20 months, sudden death occurred in four (4%) of 89 patients in G1 and two (4%) of 50 patients in G2. Twenty-three (17%) patients died of cardiac failure (18 [20%] patients in G1 and 5 [10%] patients in G2). ICD discharges occurred in 69 (78%) of 89 patients in G1 and in 36 (72%) of 50 patients in G2. The mean incidence of ICD discharges was 23 +/- 69 shocks per patient in G1 and 18 +/- 25 shocks per patient in G2 (p = NS). We conclude that concomitant aortocoronary bypass grafting during CD implantation leads to a higher perioperative mortality. Avoidance of myocardial ischemia does not significantly influence sudden death mortality nor markedly reduce the number of ICD discharges.