Results of reconstructive interventions in patients with ischemic cardiomyopathy

2020 ◽  
pp. 021849232098346
Author(s):  
Vladimir M Shipulin ◽  
Andrey S Pryakhin ◽  
Sergey L Andreev ◽  
Vladimir V Shipulin ◽  
Boris N Kozlov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Ischemic Cardiomyopathy ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Left Ventricular Reconstruction ◽  
Ventricular Reconstruction

Background Effective treatment of patients with ischemic cardiomyopathy is one of the most difficult issues in contemporary cardiac surgery. The aim of this study was to evaluate the long-term effectiveness of reconstructive interventions on the left ventricle during chronic heart failure in patients with ischemic cardiomyopathy. Methods Between March 2013 and December 2017, 178 patients underwent surgical treatment for ischemic cardiomyopathy. Isolated coronary artery bypass grafting was compared with coronary artery bypass grafting with left ventricular reconstruction, using propensity score matching analysis. The primary endpoints of the study were hospital mortality and long-term survival. Results After propensity score matching, 29 pairs of patients were compared. The 30-day hospital mortality was comparable (6.8% versus 6.8%, p = 0.952), the average follow-up was 37.4 ± 12.6 months, with no statistically significant difference in mortality from all causes ( p = 0.352). After coronary artery bypass in combination with left ventricular reconstruction, patients showed a statistically significant decrease in clinical and functional indicators of chronic heart failure compared to those who had coronary artery bypass grafting alone, in terms of peak oxygen consumption (15.3 versus 13.5 mL·kg−1·min−1, p = 0.043) and N-terminal pro-brain natriuretic peptide concentrations (298.6 versus 461.1 pg·mL−1, p = 0.032). Conclusions Compared to isolated coronary artery bypass, coronary artery bypass in combination with left ventricular reconstruction for the treatment of ischemic cardiomyopathy leads to a significant decrease in the clinical and functional parameters of chronic heart failure in the long-term postoperative period.

scholarly journals The Impact of Preoperative Thrombolysis on Long-Term Survival After Coronary Artery Bypass Grafting

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
Ioannis K. Toumpoulis ◽  
Constantine E. Anagnostopoulos ◽  
Demosthenes G. Katritsis ◽  
Joseph J. DeRose ◽  
Daniel G. Swistel
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Term Survival ◽  
Long Term Survival ◽  
Artery Bypass Grafting

Background— Coronary artery bypass grafting (CABG) is frequently used after thrombolytic therapy. However, there is little information regarding long-term survival in this setting. The purpose of the present study was to compare the long-term survival of patients subjected to CABG after thrombolysis to those without thrombolysis. Methods and Results— We studied 3760 consecutive patients with isolated CABG between 1992 and 2002. CABG patients without thrombolysis were compared with those who were treated with thrombolysis within 7 days before CABG. Groups were compared by Cox proportional hazard models and Kaplan-Meier survival plots. The propensity for thrombolysis was determined by logistic regression analysis, and each patient with thrombolysis was then matched to 5 patients without thrombolysis. One hundred ninety-six patients (5.2%) were treated with thrombolysis. Patients with thrombolysis were more likely to be male, younger, and with higher rates of unstable angina, emergency operation, recent or transmural myocardial infarction, preoperative intraaortic balloon pump, hemodynamic instability, shock, intravenous nitroglycerine, left-ventricular hypertrophy, sustained ventricular arrhythmia, and higher EuroSCORE. There were no differences in early outcome between matched groups, but the 5-year actuarial survival was higher in patients with thrombolysis (90.3±2.2% versus 78.5±1.6%; P =0.0007). After adjustment for all factors, the hazard ratio of long-term mortality for patients with thrombolysis was 0.54 (95% CI, 0.36 to 0.81; P =0.003) and, if deaths during the first 12 months were excluded, 0.46 (95% CI, 0.27 to 0.76; P =0.003). Conclusions— Patients subjected to CABG within 7 days after thrombolysis demonstrated increased long-term survival.

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