Outcome After Redo-CABG in Patients With Ischemic Cardiomyopathy and Viable Myocardium

Vittoria Rizzello ¹, Don Poldermans ^2*, Arend FL Schinkel ², Elena Biagini ², Eric Boersma ², Abdou Elhendy ², Fabiola B Sozzi ², Alberto Palazzuoli ², Alexander Maat ², Filippo Crea ³ and Jeroen J Bax ⁴

¹ The Catholic University Rome, Italy
² The Thorax Center Erasmus MC Rotterdam, Netherlands
³ The Catholic University Rome
⁴ Leiden University Medical Center, Netherlands

^* To whom correspondence should be addressed. E-mail: d.poldermans{at}erasmusmc.nl.

Accepted 21 July 2006

Abstract

Background Repeat coronary artery bypass grafting (redo-CABG) in patients with ischemic cardiomyopathy is associated with high peri-operative risk and worse long-term outcome as compared to patients with first CABG. Whether patients with viable myocardium undergoing redo-CABG have a better outcome, is unknown.

Methods 18 patients with ischemic cardiomyopathy underwent redo-CABG and 34 first CABG; all had substantial viability (25% of the left ventricle, LV) on dobutamine stress echocardiography (DSE). LV ejection fraction (LVEF) and heart failure symptoms were assessed before and 9-12 months after revascularization. Cardiac event-rate was assessed during the follow-up period (median 4 years, 25%-75% percentile 2.8-4.9 years).

Results The extent of viable myocardium on DSE was comparable in the 2 groups (11.3±3.9 segments in patients with redo-CABG vs 12.8±3.0 in patients with first CABG, P=NS). LVEF improved from 32±9% to 39±12% (P=0.01) in patients with redo-CABG and from 30±7% to 36±7% (P<0.01) in patients with first CABG; NYHA class improved from 2.5±1.1 to 1.9±0.8 (P=0.03) and from 2.7±1.0 to 1.8±0.7 (P<0.01), respectively. In patients with redo-CABG, the peri-operative mortality was 0%, post-surgery inotropic support was needed in 11%, mid-term (4-year) survival was 100%, with a total event-rate of 28%. All these variables were not statistically different from patients with first CABG.

Conclusion Patients with ischemic cardiomyopathy and substantial viability undergoing redo-CABG benefit from revascularization in term of improvement in LVEF, heart failure symptoms, angina and mid-term prognosis.

Keywords: clinical outcome, ischemic cardiomyopathy, myocardial viability, redo-CABG

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Acampa, W., Petretta, M., Evangelista, L., Nappi, G., Luongo, L., Petretta, M. P., Cuocolo, A. (2008). Stress cardiac single-photon emission computed tomographic imaging late after coronary artery bypass surgery for risk stratification and estimation of time to cardiac events. J. Thorac. Cardiovasc. Surg. 136: 46-51 [Abstract] [Full Text]  
• Sicari, R., Nihoyannopoulos, P., Evangelista, A., Kasprzak, J., Lancellotti, P., Poldermans, D., Voigt, J.-U., Zamorano, J. L., on behalf of the European Association of Echocardi, (2008). Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur J Echocardiogr 9: 415-437 [Abstract] [Full Text]