Print this pageLow Ejection Fraction Should Not Preclude Patients From Undergoing Infrainguinal Arterial Reconstruction
Beth Isreal Deaconess Medical Center, Boston, MA
Objective: Severely depressed left ventricular ejection fraction (EF) predicts shortened survival in non-surgical patients. EF has also been postulated to be an adverse prognostic indicator of non-cardiac surgical outcome. The present goal is to evaluate whether EF is predictive of outcome in infrainguinal arterial reconstruction.
Methods: We retrospectively reviewed our database of 736 patients undergoing 897 infraingunial arterial reconstructions from July 1999 to February 2002. Patients who did not have a recorded EF were eliminated from the study. Patients were divided into three groups. Group I consisted of 110 patients with an EF of 55% or greater, group II consisted of 106 patients with an EF ranging between 26% and 54%, and group III consisted of 54 patients with an EF of 25% or less. Outcomes included perioperative mortality, postoperative myocardial infarction (MI), and postoperative congestive heart failure (CHF). Significance of association was assessed by logistic regression. Survival data were analyzed using Kaplan-Meier analysis.
Results: Perioperative mortality was 1.8%, 0.9% and 3.7% in groups I, II, and III respectively (p=0.410). The incidence of post-operative MI for the three respective groups was 4.5%, 7.5%, and 11.1% (p=0.120). The incidence of post-operative CHF was 3.6%, 6.6%, and 7.4% across the three groups (p=0.158). EF in univariate and multivariate analysis did not predict any of the endpoints. Patient survival was significantly diminished in those with the lowest EF (Group III). Survival for groups I, II, and III respectively was 74.9%, 81.7%, and 61.7% at 24-months (p=0.025).
Conclusions: Decreased EF, even when less than 25%, does not predict perioperative mortality or postoperative cardiac morbidity in patients undergoing infrainguinal arterial reconstruction. EF does predict a decrease in late survival which is comparable to the non-surgical population. Therefore, low EF alone should not preclude a patient from undergoing infrainguinal arterial reconstruction.