© 2004 by BMJ Publishing Group & British Cardiac Society
MINI-SYMPOSIUM
Surgery for hibernation
Correspondence to:
Correspondence to:
Professor J R Pepper
Department of Surgery, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; j.pepper@rbh.nthames.nhs.uk
Keywords: surgery; hibernation; ischaemic cardiomyopathy; coronary artery bypass grafting
Abbreviations: CABG, coronary artery bypass graft surgery; CASS, coronary artery surgery study; IABP, intra-aortic balloon pump; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; WMS, wall motion score
| The first 150 words of the full text of this article appear below. |
In the early 1980s Rahimtoola reviewed the results of coronary bypass surgery trials1 and identified patients with coronary artery disease and chronic left ventricular dysfunction that improved upon revascularisation. The results of medical treatment for ischaemic cardiomyopathy have been poor. Coronary artery bypass grafting provides superior long term survival, but may be associated with a high operative mortality and significant morbidity for certain patient subgroups with heart failure and very low left ventricular ejection fraction (LVEF). The potential benefits of revascularisation are to reduce the ischaemic burden, to reduce the arrhythmic potential, to reduce maladaptive growth, and to restore the coordinated movement in dysfunctional myocardial segments.
Data from the coronary artery surgery study (CASS) registry for patients with LVEF < 35% involved 651 patients.23 The five year survival was significantly better in surgical patients (68%) than in the medical group (54%). The contrast became more pronounced in patients with LVEF
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