TERM RESULTS AFTER MYOCARDIAL REVASCULARISATION IN PATIENTS
WITH END-STAGE HEART FAILURE - EJECTION FRACTION <=20%
N. Radovanović, Lj. Petrović, B. Mihajlović, S Ničin, J. Selestiansky,
M. Fabri, P. Kovačević, M. Mijatov, Z Konstantinović and S.
Clinic of Cardiovascular Surgery, Novi Sad, Yugoslavia
Material and methods: There were 397 patients
(352 male, 45 female, mean age 58,1 years) in end stage heart
failure -ejection fraction (EF) lower or equal to 20% who had
undergone conventional surgery - myocardial revascularisation
and in 32% (129/397) associated procedures such as mitral and
tricuspid annuloplasty, left ventricular aneurysmectomy, etc.
Previous cardiac decompensation was registered in 83% (330/397)
of the patients. Mean EF was 18,9±2,2% (10-20%) mean cardiac index
2,5±0,5 lit/min/m? (1,2-3,6 lit/min/m?) mean systolic pulmonary
artery pressure 38,0±13,5 mmHg (14-100 mmHg) and mean wedge 28,3
±9,4 mmHg (10-60 mmHg). Because of diffuse and distal coronary
disease in 56% (222/397) of the patients endarterectomy of coronary
arteries had to be performed. Results: Postoperative mortality
(PM) -30 days was 7,8% (31/397). The follow-up study was done
for 216 pts.
Conclusions: In many institutions, patients with EF <=20%
are considered to be inoperable, especially if they've diffuse
and distal coronary disease and they are at the waiting list for
cardiac transplantation. In our series PM was acceptably low -7,9%
(31/397) and long term survey has shown good results. We conclude
this group of patients can derive from conventional surgery.