Perioperative and Late Outcome in Patients with Left Ventricular Ejection Fraction of 35% or Less Who Require Major Vascular Surgery

Survival in patients with diminished left ventricular ejection fraction (EF) is reduced after major vascular surgery. The objective of this study was to determine perioperative (30-day) and subsequent outcome after major vascular surgery in those with severe cardiac dysfunction, defined by EF being 35% or less (normal EF greater than 50%). From Aug. 1, 1984 to Jan. 1, 1988, 35 patients with EF equal to 27.7% +/- 6.1% (mean +/- 1 standard deviation) have required 47 major vascular procedures: 53% (n = 25) were limb revascularizations; 21% (n = 10) were direct aortoiliac aneurysm repairs: 23% (n = 11) were carotid endarterectomies: one patient had transaortic renal endarterectomy. Two deaths occurred within the first 30 days, yielding a 4.3% perioperative mortality rate (2 of 47 procedures). The cumulative mortality rate for the entire group during follow-up of 410 +/- 390 days was 40% (14 of 35 patients). Most late deaths (71%) occurred within the first 6 months after surgery and each was due to cardiovascular complications. Survival for those with an EF of 29% or less was significantly worse than for those with an EF greater than 29%, determined by life-table analysis (p less than 0.012, Mantel-Cox). The cumulative mortality rate was 59% with an EF of 29% or less and 18% in those with an EF greater than 29% (p less than 0.029, two-tailed Fisher exact test). The perioperative mortality rate for those with an EF of 35% or less who require major vascular surgery is acceptable, but overall survival during follow-up is diminished.(ABSTRACT TRUNCATED AT 250 WORDS)