Coronary Artery Bypass Grafting in Patients With Reduced Left Ventricular Ejection Fraction: Insights From a Single–center Experience

Introduction Reduced left ventricle ejection fraction (LVEF) identifies a frail, high–risk population undergoing coronary artery by–pass grafting (CABG) whose benefit remains debated. We assessed the impact of baseline ventricular dysfunction on early outcomes, long–term prognosis, and ventricular function recovery after isolated CABG. Methods Retrospective single–center study of 2230 consecutive patients undergoing isolated CABG (2017–2024). Patients were stratified by baseline LVEF: ≤35%, 36–49%, ≥50%. Early postoperative outcomes, complications, and rescue after complications were recorded. Survival and cardiovascular rehospitalization were assessed using Kaplan–Meier analysis; predictors were identified by Cox regression. Recovery of ventricular function was evaluated in 1092 survivors with follow–up echocardiography (ΔLVEF). Results Patients with lower LVEF had a higher baseline comorbidity burden (diabetes 46%, CKD 29%, COPD 21%, NYHA ≥III 52%) and more frequent urgent presentation (41%). Postoperative complications were more common in reduced LVEF: respiratory failure (5.8%), atrial fibrillation (25.2%), sepsis (1.8%), and transient neurologic deficits (8.4%), with longer ICU and hospital stay. In–hospital mortality was low (0.6%) and did not differ significantly across LVEF groups. At follow–up, patients with LVEF ≤35% showed lower 8–year survival (55%) and lower freedom from cardiovascular rehospitalization (34%) (log–rank p‹0.001). At multivariable analysis, advanced age, diabetes, renal failure, COPD, NYHA class ≥III, acute coronary syndrome, and major postoperative complications were independent predictors of mortality. LVEF recovery was assessable in 1092 survivors; improvement occurred in ∼88% of those with LVEF ≤35%, with a mean LVEF increase of +14.0 percentage points (p‹0.001). Conclusions CABG can be safely performed in patients with reduced LVEF, with very low operative mortality. Although reduced baseline LVEF remains associated with worse long–term outcomes, surgical revascularization yields substantial recovery of ventricular function in most patients with severe dysfunction, supporting surgical revascularization in ischemic cardiomyopathy.