Late Results with Concomitant Coronary Artery Bypass Grafting and ICD Implantation

Background: To determine the influence of left ventricular function on the long‐term survival of patients with coronary artery disease and lethal ventricular arrhythmias, who undergo concomitant coronary artery bypass grafting (CABG) and implantable cardiovertor defibrillator (ICD) implantation, we studied survival in 54 consecutive patients who underwent CABG and ICD implantation. Methods: Group I consisted of 35 patients with left ventricular ejection fraction (LVEF) ± 35% (mean 25.3 ± 5.6) and Group II consisted of 19 patients with LVEF > 35% (mean 47.5 ± 6.6). The two groups were similar with regards to age, gender, clinical presentation, induced arrhythmias, and the number of grafts placed at the time of surgery. Results: Two in‐hospital deaths (3.7%) occurred, both in Group I. During follow‐up (42.5 ± 21.8 months), there were 10 deaths in Group I (1 noncardiac, 1 sudden, and 8 heart failure), and 1 death in Group II (heart failure) (p < 0.04). Conclusions: Concomitant CABG and ICD implantation can be performed with an acceptable in‐hospital mortality, even in patients with poor left ventricular function. Although freedom from sudden cardiac death remains excellent, overall long‐term survival is limited by refractory heart failure, especially in those patients with left ventricular dysfunction at the time of surgery.