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Coronary revascularization rather than cardiac transplantation for chronic ischemic cardiomyopathy.

Publication ,  Journal Article
Kron, IL; Flanagan, TL; Blackbourne, LH; Schroeder, RA; Nolan, SP
Published in: Ann Surg
September 1989

Patients with very poor ventricular function have been thought to be highly vulnerable to elective myocardial revascularization. Ischemic cardiomyopathy is now the major indication for cardiac transplantation. The 2-year survival of medically treated patients with ejection fractions less than 20%, but who are not sufficiently symptomatic for cardiac transplantation, is less than 25%. At our institution we have taken an aggressive approach by using myocardial revascularization for chronic ischemic cardiomyopathy. Between 1983 and 1988, 39 patients with preoperative ejection fractions less than 20% underwent coronary artery bypass. Patients were excluded if they had valvular heart disease other than mild to moderate mitral regurgitation, required resection of a left ventricular aneurysm, or required emergency operation for acute coronary occlusion. Mean age was 63.3 years (range, 43 to 80 years) and 31 were men. Mean preoperative ejection fraction was 18.3% (range, 10% to 20%) and the mean preoperative left ventricular end diastolic pressure was 22 mm Hg (range, 8 mm Hg to 38 mm Hg). There was one operative death (2.6%). Mean follow-up was 21 months (range, 3 to 60 months) with eight late deaths (a total mortality rate of 21%). Seven deaths were due to arrhythmias. Three patients continued to have severe heart failure, one of whom underwent successful cardiac transplantation. By life table analysis, there was a 3-year survival rate of 83%. With the present shortage of cardiac transplant donors, myocardial revascularization for ischemic cardiomyopathy is a reasonably effective means for preserving residual ventricular function.

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Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

September 1989

Volume

210

Issue

3

Start / End Page

348 / 352

Location

United States

Related Subject Headings

  • Surgery
  • Stroke Volume
  • Postoperative Period
  • Postoperative Complications
  • Myocardial Revascularization
  • Middle Aged
  • Male
  • Humans
  • Heart Transplantation
  • Female
 

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Kron, I. L., Flanagan, T. L., Blackbourne, L. H., Schroeder, R. A., & Nolan, S. P. (1989). Coronary revascularization rather than cardiac transplantation for chronic ischemic cardiomyopathy. Ann Surg, 210(3), 348–352. https://doi.org/10.1097/00000658-198909000-00011
Kron, I. L., T. L. Flanagan, L. H. Blackbourne, R. A. Schroeder, and S. P. Nolan. “Coronary revascularization rather than cardiac transplantation for chronic ischemic cardiomyopathy.Ann Surg 210, no. 3 (September 1989): 348–52. https://doi.org/10.1097/00000658-198909000-00011.
Kron IL, Flanagan TL, Blackbourne LH, Schroeder RA, Nolan SP. Coronary revascularization rather than cardiac transplantation for chronic ischemic cardiomyopathy. Ann Surg. 1989 Sep;210(3):348–52.
Kron, I. L., et al. “Coronary revascularization rather than cardiac transplantation for chronic ischemic cardiomyopathy.Ann Surg, vol. 210, no. 3, Sept. 1989, pp. 348–52. Pubmed, doi:10.1097/00000658-198909000-00011.
Kron IL, Flanagan TL, Blackbourne LH, Schroeder RA, Nolan SP. Coronary revascularization rather than cardiac transplantation for chronic ischemic cardiomyopathy. Ann Surg. 1989 Sep;210(3):348–352.

Published In

Ann Surg

DOI

ISSN

0003-4932

Publication Date

September 1989

Volume

210

Issue

3

Start / End Page

348 / 352

Location

United States

Related Subject Headings

  • Surgery
  • Stroke Volume
  • Postoperative Period
  • Postoperative Complications
  • Myocardial Revascularization
  • Middle Aged
  • Male
  • Humans
  • Heart Transplantation
  • Female