Complications and Mortality after CABG Surgery in Patients with Reduced Ejection Fraction

DOI: https://doi.org/10.30702/ujcvs/22.30(03)/KS034-0914
Keywords: ischemic heart disease with reduced left ventricular ejection fraction, coronary artery bypass grafting, myocardial infarction, postoperative complications, mortality, acute heart failure, respiratory failure, renal failure

Abstract

Coronary artery bypass grafting (CABG) is a complex, high-tech surgical intervention. Its success depends not only on the skill and experience of the surgeon but equally on the coherence of work and professionalism of all services involved in the operation. Severe left ventricular (LV) dysfunction after heart surgery is one of the main causes of cardiogenic shock, which is characterized by a local transient reduction of myocardial contractility (“stunned” myocardium) and/or significant cell damage caused by ischemia. In this state, systemic metabolic disorders often occur: increased concentration of free fatty acids, lactic acidosis, hypoxemia, and increased catecholamine content. General approaches to determining the risk of CABG surgery have not been definitively established. In addition, the data concerning the choice of optimal tactics in patients with a reduced ejection fraction (EF) are still limited. Relatively high early operative mortality in patients with reduced left ventricular EF requires further serious study.

The aim. To determine the dominant complications and causes of fatal cases in patients with reduced LV contractility after CABG surgery.

Materials and methods. The study included 210 patients with EF of 35% or less, who underwent CABG at the National Amosov Institute of Cardiovascular Surgery in the period from 01/01/2015 to 12/31/2021. Among them were 190 men (90.5%) and 20 women (9.5%). The age of the patients ranged from 29 to 83 years (61.1±8.9). Most patients underwent revascularization of three or more arteries.

Results and discussion. In the group of patients with EF 35-30% in the postoperative period, acute heart failure (HF) occurred in 5 (3.8%) cases, respiratory failure (RF) was observed in 3 (2.3%) cases, renal failure in 3 (2.3%) cases, central nervous system (CNS) complications in 5 (3.8%). At the same time, along with the decrease in EF, the frequency of postoperative complications increased. In patients with EF below 24%, the frequency of postoperative complications increased significantly: acute HF was noted in 3 (15%) cases, RF in 5 (25%) cases, renal failure in 2 (10%) cases, CNS complications were noted in 0 (0%) cases. The duration of artificial lung ventilation increased significantly to 24.9±27.7 hours, the length of stay in the intensive care unit increased to 12.8±8 days, and the total length of stay of the patient in the hospital to 20.2±11.7 days.

Conclusion. Based on the data we received, we concluded that: in patients with reduced LV myocardial contractility, such complications as HF, RF and renal failure, CNS complications most often occur; in addition, their frequency is higher than that in patients with preserved EF and increases with its decrease; one of the most frequent and life-threatening complications in this group of patients was acute HF; the use of intra-aortic balloon pump allows to avoid or improve treatment of HF and, at the same time, to increase survival in patients with reduced LV contractility.

References

  1. Louagie YA, Jamart J, Gruslin A. Do coronary bypass graft flows differ between on-pump and off-pump operations? Ann Thorac Surg. 2005;79(6):2004-12. https://doi.org/10.1016/j.athoracsur.2004.11.022
  2. Rudenko AV, Ursulenko VI, Kupchynskiy AV, Spysarenko SP, Malysheva TA. [10 000 Consecutive off Pump Coronary Artery Bypass Grafting Operations Performed in a Single Cardiac Surgery Clinic]. Cardiovascular Surgery Herald. 2016;(1(24)):6-8. Russian.
  3. Velazquez EJ, Lee KL, Jones RH, Al-Khalidi HR, Hill JA, Panza JA, et al. Coronary-artery bypass surgery in patients with ischemic cardiomyopathy. N Engl J Med. 2016;374(16):1511-20. https://doi.org/10.1056/NEJMoa1602001
  4. Petrie MC, Jhund PS, She L, Adlbrecht C, Doenst T, Panza JA, et al.; STICH Trial Investigators. Ten-Year Outcomes After Coronary Artery Bypass Grafting According to Age in Patients With Heart Failure and Left Ventricular Systolic Dysfunction: An Analysis of the Extended Follow-Up of the STICH Trial (Surgical Treatment for Ischemic Heart Failure). Circulation. 2016;134(18):1314-24. https://doi.org/10.1161/CIRCULATIONAHA.116.024800
  5. Gogayeva O. [Coronary Bypass Grafting for High-Risk Patients (Literature review)]. Ukrainian Journal of Cardiovascular Surgery. 2020;(1(38)):7-12. Ukrainian. https://doi.org/10.30702/ujcvs/20.3803/002007-012
  6. Tunç M, Şahutoğlu C, Karaca N, Kocabaş S, Aşkar FZ. Risk Factors for Prolonged Intensive Care Unit Stay After Open Heart Surgery in Adults. Turk J Anaesthesiol Reanim. 2018;46(4):283-91. https://doi.org/10.5152/TJAR.2018.92244
  7. Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Onnasch JF, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003;75(2):472-8. https://doi.org/10.1016/s0003-4975(02)04370-9
  8. Brener SJ, Lytle BW, Casserly IP, Ellis SG, Topol EJ, Lauer MS. Predictors of revascularization method and long-term outcome of percutaneous coronary intervention or repeat coronary bypass surgery in patients with multivessel coronary disease and previous coronary bypass surgery. Eur Heart J. 2006;27(4):413-8. https://doi.org/10.1093/eurheartj/ehi646
  9. Darwazah AK, Bader V, Isleem I, Helwa K. Myocardial revascularization using on-pump beating heart among patients with left ventricular dysfunction. J Cardiothorac Surg. 2010;5:109. https://doi.org/10.1186/1749-8090-5-109
  10. Légaré JF, Buth KJ, King S, Wood J, Sullivan JA, Hancock Friesen C, et al. Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump. Circulation. 2004;109(7):887-92. https://doi.org/10.1161/01.CIR.0000115943.41814.7D
  11. Rudenko AV, Nastenko IA, Zhurba OA, Nosovets OK, Shardukova YV, Lasoryshinets VV. [Evaluation of risk factors for operations coronary bypass surgery on a beating heart]. Cybernetics and Computer Engineering Journal. 2017;(2(188)):75-87. Russian. https://doi.org/10.15407/kvt188.02.075
  12. Caputo M, Reeves BC, Rajkaruna C, Awair H, Angelini GD. Incomplete Revascularization During OPCAB Surgery is Associated With Reduced Mid-Term Event-Free Survival. Ann Thorac Surg. 2005;80(6):2141-7. https://doi.org/10.1016/j.athoracsur.2005.05.077
  13. Greaves SC, Rutherford JD, Aranki SF, Cohn LH, Couper GS, Adams DH, et al. Current Incidence and determinants of perioperative myocardial infarction in coronary artery surgery. Am Heart J. 1996;132(3):572-8. https://doi.org/10.1016/s0002-8703(96)90240-9
  14. Thourani VH, Weintraub WS, Stein B, Gebhart SS, Craver JM, Jones EL, et al. Influence of diabetes mellitus on early and late outcome after coronary artery bypass grafting. Ann Thorac Surg. 1999;67(4):1045-52. https://doi.org/10.1016/s0003-4975(99)00143-5
  15. Weightman WM, Gibbs NM, Sheminant MR, Thackray NM, Newman MA. Risk prediction in coronary artery surgery: a comparison of four risk scores. Med J Aust. 1997;166(8):408-11. https://doi.org/10.5694/j.1326-5377.1997.tb123190.x
  16. Orr RK, Maini BS, Sottile FD, Dumas EM, O’Mara P. A Comparison of Four Severity-Adjusted Models to Predict Mortality After Coronary Artery Bypass Graft Surgery. Arch Surg. 1995;130(3):301-6. https://doi.org/10.1001/archsurg.1995.01430030071015
Published
2022-09-26
How to Cite
Kashchenko, Y. V., Sakevych, D. P., Arvanitaki, S.-A. S., & Rudenko, S. A. (2022). Complications and Mortality after CABG Surgery in Patients with Reduced Ejection Fraction. Ukrainian Journal of Cardiovascular Surgery, 30(3), 9-14. https://doi.org/10.30702/ujcvs/22.30(03)/KS034-0914
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 30 No 3 2022
Section
ISCHEMIC HEART DISEASE