الفهرس 
Introduction & Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Objective: Surgical myocardial revascularization became one of the most effective and long-lasting therapies to treat atherosclerotic coronary artery disease. The practicing cardiac surgeon is often asked ”Is coronary bypass surgery indicated in this patient even with his poor left ventricular ejection fraction?Aim of Work: The present study was conducted in Mansoura University Hospital, Nasser Institute for research and treatment and Mayo Clinic Rochester, MN. In this study 100 patients were classified into two groups: first group; 50 patients with LVEF<35% were pair matched to 50 patients with LVEF>50% in the second group.Methods: All patients were subjected to preoperative clinical assessment, ECG, echocardiography, coronary angiography, complete blood picture, liver function, and kidney function tests. Viability studies were done on all patients in the first group (LVEF<35%). All patients were subjected to isolated CABG utilizing cardiopulmonary bypass. The data were collected and included clinical assessment for postoperative morbidity, mechanical ventilation with the assessment of the time of ventilation, the use of inotropic medications or intra-aortic balloon, reopening for bleeding, total ICU stay, total hospital stay, laboratory assessment, improvement in NYHA class and LVEF. Follow up was done after 6 month for all patients.Results: Patients in the first group spent more time on mechanical ventilation; median of 8.3, range (2.6: 70.8) hours compared to 6.3 (3 – 90.8) hours in second group patients, with significant statistical difference. There was a significant difference in the incidence of having any of the postoperative complications; first group was 42% compared to 18% in second group. Two patients suffered bleeding requiring retake to the operating room in the first group, compared to only one patient in the second group. There was no significant difference in the incidence of stroke comparing both groups. One patient suffered renal impairment requiring dialysis in first group, compared to none in the second group. Of note, there was significant improvement in the patients clinical status as well as Echo findings; first group NYHA class improved from 2.72 ± 0.95 preoperatively to 1.26 ± 0.44 six months after surgery, And second group NYHA class improved from 2.74 ± 0.96 to 1.28 ± 0.45 six months after surgery. In our study cardiopulmonary bypass time was found to be the only independent risk factor predicting the occurrence of postoperative complications when both study groups were tested(p<0.036). While age, sex, NYHA class, preoperative MI, Diabetes, BMI and aortic cross clamp time, all were found not to be independent risk factors.
Conclusion: CABG in patients with severely impaired LV function appears beneficial if ischemia is reversible. Systolic heart function improves significantly after surgical revascularization in patients with coronary artery disease and hibernating myocardium. Results of surgical revascularization in patients with depressed LVEF (<35%) are comparable to patients with LVEF>50%. Preoperative patient evaluation and risk stratification is of outmost importance to improve outcomes. If characteristics associated with poor survival are identified, improved patient selection may be possible.