Viability assessment prior to heart surgery

Patients with advanced coronary artery disease and severe left ventricular dysfunction are at higher risk for peri- and postoperative complications associated with CABG. Therefore, the selection of patients, who are likely to benefit from the long-term effect of CABG is an important clinical issue. We retrospectively evaluated 88 patients with coronary artery disease and severe left ventricular dysfunction (EF≤0,35) who were considered candidates for CABG. 43 patients were selected for CABG on the basis of clinical presentation and angiographic data (group A), and 45 of 55 patients were selected according to the extent of viable myocardium determined by PET (group B) in addition to clinical presentation and angiographic data. Patients of group B had a less complicated postoperative recovery and were discharged earlier from ICU (p=0.04). They required lower doses of catecholamines (p=0.05) and demonstrated a significantly decreased incidence of low output syndrome (p=0.04). However, most important was the difference in early and mid-term survival. There was an in-hospital mortality rate of 11.6% in group A and none in group B (p=0.04). After twelve months, the survival rate was 77% in group A and 93% in group B (p=0.03). These data suggest that selection of patients with severe left ventricular dysfunction on the basis of PET viability assessment in addition to clinical and angiographic data may lead to postoperative recovery with low early mortality and promising short-term outcome. Therefore, viability studies permit selection of patients, who are at low risk for serious perioperative complications. (orig.)