Research Article
Volume 7 Issue 9 - 2020
Does the Myocardial Viability Influence the Long-Term Survival after Coronary Surgery in Ischemic Cardiomyopathy?
Olivier JL Jegaden1,2,3*, Alhaitham Mahdi1, Margaux PO Jegaden4 and Salah Ashafy5
1Department of Cardiac Surgery, Mediclinic Middle East, Abu Dhabi, UAE
2MBRU University, Dubai, UAE
3UCLB University Lyon1, Lyon, France
4Department of Surgery, Kremlin-Bicetre Hospital, Paris, France
5Department of Cardiac Surgery, Zayed Military Hospital, Abu Dhabi, UAE
*Corresponding Author: Olivier JL Jegaden, Department of Cardiac Surgery, Mediclinic Middle East, Abu Dhabi, UAE.
Received: July 16, 2020; Published: August 31, 2020




Abstract

Background: The relationship between myocardial viability and the long-term treatment effect of CABG in patients with ischemic cardiomyopathy remains uncertain. The current study was conducted to determine the relationship between the presence of myocardial viability and changes in left ventricular ejection fraction during the early stages of follow-up after CABG and their effects on the long-term prognosis of the patients.

Methods: The study group consisted of a consecutive series of 126 patients who met four criteria: (1) an angiographic resting left ventricular ejection fraction (LVEF) less than 0.40, (2) preoperative radionuclide investigations with thallium SPECT and planar evaluation of LVEF, (3) an isolated CABG procedure and (4) a prospective assessment of myocardial function and perfusion using same SPECT analysis in survivors 1 year after surgery. The survival was obtained in 2019 with a postoperative follow-up of 10.6 ± 7.4 years and 94% complete.

Results: Early and 1-year mortality were respectively 3.2% and 5.7%. At 1-year, the mean LVEF increase from 31 ± 9% to 34 ± 10% (p = 0.01) and the mean LV end-diastolic (LVED) volume decreased from 317 ± 112 to 285 ± 108 ml (p = 0.023). There was a significant correlation between the changes in LVEF, the changes in LVED volume and preoperative hibernating myocardium defined as improvement in redistribution thallium defects. The 10-year and 15-year survival were respectively 48 ± 8% and 27 ± 8%. Only age, preoperative LVEF and complete revascularization were identified as independent prognosis factors of survival. The overall incidence of death was not influenced by preoperative hibernating myocardium or postoperative improvement in LV function.

Conclusion: The postoperative improvement in left ventricular function, more likely to occur among patients with myocardial viability, is not an important mechanism for the long-term survival of patients with ischemic cardiomyopathy treated surgically. Complete revascularization appears to be more effective to stabilize the underlying cardiomyopathy and to reduce the incidence of late mortality.

Keywords: Coronary Bypass Surgery; Left Ventricular Dysfunction; Myocardial Viability; Myocardial Hibernation; SPECT Assessment

References

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  10. Panza JA., et al. “Myocardial viability and long-term outcomes in ischemic cardiomyopathy”. The New England Journal of Medicine 381 (2019): 739-748.
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Citation: Olivier JL Jegaden., et al. “Does the Myocardial Viability Influence the Long-Term Survival after Coronary Surgery in Ischemic Cardiomyopathy?”. EC Cardiology 7.9 (2020): 85-93.

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