1031-36 Results of Coronary Artery Bypass Grafting in Patients with Chronic Congestive Heart Failure: A Ten-year Experience with 203 Patients

From 1983 to 1992, 203 patients with preoperative symptoms of chronic CHF and not angina underwent primary CABG for ischemic cardiomyopathy. This represented 3% of all patients undergoing CABG, however, this figure rose to 8% over the last two years of the study. Patients with valvular lesions, left ventricular aneurysms or those with acute post infarction heart failure were excluded. The mean age was 67 years and 63% of the patients were male. 92% of the patients were in NYHA Class III or IV prior to undergoing CABG. The mean preoperative ejection fraction was 34% ± 13% and the mean LVEDPwas 20.7 mmHg ± 8.4 mmHg. A LIMA graft was used in 68% of the patients. Follow-up was 98% complete. The hospital mortality was 6.0% and the actuarial survival at 5 years was 59%. An improvement in NYHA class occurred in 75% of the surviving patients with a mean improvement of 1.6 ± 0.6 NYHA classes; 18% of the survivors remained the same and 7% were worse. Univariate analysis identified risk factors for hospital death as emergency operation, recent myocardial infarction l 30 days), the need for IABP and non use of a LIMA graft. Use of the LIMA did predict late survival (p = 0.02), however did not affect NYHA class in the surviving patients. We conclude that CABG is effective in ameliorating symptoms of chronic congestive heart failure in patients suffering from chronic ischemic cardiomyopathy and can be performed with acceptable early and late mortality.