Ergebnisse der operativen Revaskularisation von Patienten mit koronarer Herzkrankheit und eingeschränkter linksventrikulärer Funktion

Abstract

Ziel: Die Ergebnisse nach aortokoronarer Bypassoperation (CABG) unterscheiden sich bei Patienten mit schlechter linksventrikulärer Pumpfunktion deutlich von denen bei Patienten ohne Einschränkungen derselben. Das Ziel dieser Studie war die Untersuchung des Einflusses einer reduzierten linksventrikulären Ejektionsfraktion (LVEF), eines vergrößerten linksventrikulären enddiastolischen Volumenindexes (LVEDVI) und eines erhöhten linksventrikulären enddiastolischen Druckes (LVEDP) auf das postoperative "outcome". Material und Methodik: Im Rahmen dieser retrospektiven Studie wurden 148 Patienten mit einer koronaren Herzkrankheit (KHK) und eingeschränkter Ejektionsfraktion (EF

Aim: Results of coronary artery bypass grafting (CABG) in patients with poor left ventricular ejection fraction (LVEF) differ from those in patients with normal LVEF. The aim of the study was a investigation into the influence of reduced LVEF, augmented left ventricular enddiastolic volume index (LVEDVI) and elevated left ventricular enddiastolic pressure (LVEDP) on the outcome of CABG. Methods: 148 Patients with LVEF < 50% underwent CABG. Exercise tolerance and LVEF were determined pre- and postoperatively. Three subgroups were built to distinguish the influence of reduced LVEF on postoperative outcome. Group I: LVEF < 30%, group II: 30% < LVEF < 40%, group III: 40% < LVEF < 50%. Results: Exercise tolerance rised from a preoperatively mean of 70 Watt to 97 Watt postoperatively. Mean NYHA class was 2,7 pre- and 1,7 postoperatively. There were no significant differences in the results of the three subgroups. Perioperative mortality in group I was 6,3%. Actuarial 1 and 2 years survival in this group is at 81 and 70% respectively. These results differ clearly from those of group II and III. Perioperativ mortality was 2,2% in group II and 1,4% in group III. Actuarial 1 and 2 years survival is at 93 and 84% in group II and at 95 and 83% in group III. There was no difference in postoperative outcome of patients with LVEDP > 12mmHg in comparison to patients with LVEDP < 12mmHg. Patients with LVEDVI > 100 ml/m2 had a sifnificant higher peri- and postoperative mortality than patients with LVEDVI < 100 ml/m2. Mean LVEDVI of those patients, whose LVEF increased postoperatively, was 84 ml/m2. Patients with no change in LVEF had a mean LVEDVI of 122 ml/m2. Conclusion: CABG in patients with reduced LVEF improves exercise tolerance and quality of life. Poor LVEF (< 30%) and augmented LVEDVI are predicting higher peri- and postopertive mortality. Postoperative increase of LVEF is unlikely in patients with enlarged left ventricels.