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SURGICAL OPTIONS FOR THE TREATMENT OF HEART FAILURE - PART 2

Nhiều sự kiện bất lợi có thể đi kèm với tái thuật (mặc dù kinh nghiệm và kỹ thuật tối ưu), bao gồm cả atheroembolism ghép. Không giống như các bệnh nhân với fiinction bảo quản, EF thấp bệnh nhân không có lợi nhuận để tồn tại quanh tác nhồi máu cơ tim. Trong một phân tích thống kê chính xác | Coronary Artery Bypass for Advanced Left Ventricular Dysfunction 25 risk for CABG.31 Only 8 of our series represent re-do s. Many adverse events may accompany re-do CABG despite experience and optimal technique including graft atheroembolism. Unlike the patient with preserved function the low EF patient does not have the margin to survive peri-operative myocardial infarction. In a precise statistical analysis Kron and colleagues at University of Virginia found risk of peri-operative mortality to be a full 12 in their low EF re-do patients. We advise caution in accepting redo patients for low EF CABG. Transplantation may be a better option. Tarsets. There is general agreement among all centers on one additional selection criterion In real estate the important factor is location location location . For low EF CABG it is targets targets targets Without suitable distal sites at which to touch down low EF c ABG is not appropriate. The University of Virginia group have demonstrated this in a statistical analysis based on blinded re-reading of the pre-operative arteriograms.12 Only Radovanovic from Yugoslavia encourages operation despite poor targets in low EF patients he encourages extensive coronary endarterectomy for such patients.32 Although his reported results are good most authorities in this country shy away from this technique in advanced left ventricular dysfunction. Presence of mitral regurgitation. We do not deny patients surgery on the basis of mild or moderate mitral insufficiency which is quite common in these patients with advanced left ventricular dysfunction. Mitral insufficiency generally accompanies the process of left ventricular dilatation which causes a shift in shape of the left ventricle from ovoid to spherical. We find that the severity of mitral insufficiency is often decreased by effective revascularization. The avoidance of direct surgery on the mitral valve in these patients is consistent with the approach of Carpentier who has emphasized .