Why the study?
As coronary artery bypass grafting is used with increasing frequency in patients with reduced ejection fraction secondary to ischemic cardiomyopathy, a review of operative considerations in this vulnerable population was needed.
In patients with ischemic cardiomyopathy and reduced ejection fraction undergoing CABG, preoperative optimization and careful selection of intraoperative techniques are crucial for improving outcomes.
PURPOSE OF REVIEW: As the number of patients with reduced ejection fraction secondary to ischemic cardiomyopathy (ICM) increases, coronary artery bypass grafting is being used with increasing frequency. In this review, we summarize the different operative considerations in this vulnerable patient population. RECENT FINDINGS: Preoperative optimization with mechanical circulatory support devices, especially in the setting of hemodynamic instability, can reduce perioperative morbidity and mortality. The advantage of advanced techniques, such as off-pump CABG and multiple arterial grafting remains unclear. Concomitant procedures, such as ablation for atrial fibrillation remain important considerations that should be tailored to the individual patients risk profile. SUMMARY: Despite improvements in perioperative care of patients undergoing CABG, patients with a reduced ejection fraction remain at elevated risk of major morbidity and mortality. Preoperative optimization and careful selection of intraoperative techniques can lead to improved outcomes.
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Robinson et al. (2021) studied this question.
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