| [Objective] There is a tendency of increasing incidence rate of coronary heart disease in recent years. Some of them accompany with severe chronic left ventricular dysfunction (Patients with ventricular aneurysm and moderate or severe mitral reflux are excluded). As one of the representative treatments of revascularization principle in these patients, only few research papers about coronary artery bypass grafting (CABG) have been carried out that further study is still continuing. Our resea rch aims to discuss appropriate operative indications and to assess prognosis in patients of coronary heart disease with severe chronic left ventricular dysfunction after coronary artery bypass grafting in order to provide a reference for application and extension of CABG within these patients.[Methods] A consecutive series of 98 patients who were final diagnosed as coronary heart disease with severe chronic left ventricular dysfunction but not accompanied with ventricular aneurysm and moderate or severe mitral reflux underwent CABG were studied from October 1996 to December 2007 retrospectively. Statistics including the general state {age, gender, body mass index (BMI), past history, personal history and family history}, the laboratory index {ultrasonic echocardiogram(UCG), myocardial perfusion gated SPECT imaging (MPI), N-terminal pro-brain natriuretic peptide (NT-proBNP) level in serum} and the data of perioperative period (operation time, mechanical venti- lation time, application for vasoactive drugs, complications, mortality) were collected and analyzed by software SPSS 13.0.[ Results ] The parameters of post-operative and early follow-up UCG indicate conspicuous amelioration than that of preoperative (P<0.05). Compared with cardiopul-onary bypass (CPB) subgroup, shorter mean operation time(t=-3.589, P=0.001), shorter assisted mechanical ventilator time(Z=-1. 985, P=0.047) , shorter average hospitalized days postoperative (Z=-4.030, P=0.000), less vasoactive drugs application(χ~2=4.907, P=0.027) and fewer complications(P=0.039) in off-pump coronary artery bypass (OPCAB) subgroup. The parameters of ultrasonic echocardiogram in 3 months' follow-up showed better effects in OPCAB subgroup than in CPB subgroup with the indicators left ventricular ejection fraction (LVEF, t=2.037, P=0.045) and left ventricular end-diastolic dimension (LVEDD, t=-2.056, P=0.043). The degree of improvement is positive correlated with the amount of cardiocyte and negative correlated with the level of NT-proBNP in blood serum. Greater change of LVEF, LVEDD, left atrial dimension (LAD) postoperative were closely correlated to shorter operation time (t=0. 006), methods of off-pump coronary artery bypass (t=0. 018) and lower BMI (t=0. 002) . The survival rate of one month, half a year, one year, two years, and three years were 99, 99, 97, 97 and 93%, respectively.[Conclusion] Revascularization is a valid and an effective treatment principle to patients of coronary heart disease with severe chronic left ventricular dysfunction but not accompanied with ventricular aneurysm and moderate or severe mitral reflux. CABG can rapidly improve the heart function and patients' life quality no matter under OPCAB or CPB. But it appears relatively better of echocardiographic functional recovery in OPCAB subgroup than in CPB subgroup. The more amount of cardiocyte, the lower level of NT-proBNP in serum preoperative, the more satisfactory outcome will occur. The operation time, the assistant means of bypass and the BMI are strongly correlated with the recovery of heart function postoperative. Through CABG, Early outcome indicates that these patients have a good survival rate. |
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