Coronary artery bypass grafting in patients with severe left ventricular dysfunction can be performed with acceptable risk, though comprehensive studies on long-term outcomes are lacking.
Despite high perioperative risks, advancements in surgical techniques and preoperative optimization allow CABG to be performed with acceptable risk in patients with severe left ventricular dysfunction, emphasizing the need for a heart team approach.
PURPOSE OF REVIEW: The surgical management of patients undergoing coronary artery bypass grafting (CABG) with low ejection fraction presents unique challenges that require meticulous attention to details and good surgical technique and judgement. This review details the latest evidence and best practices in the care of such patients. RECENT FINDINGS: CABG in patients with low ejection fraction carries a significant risk of perioperative mortality and morbidity related to the development of postcardiotomy shock. Preoperative optimization with pharmacological or mechanical support is required, especially in patients with cardiogenic shock. Rapid and complete revascularization is what CABG surgeons aim to achieve. Multiple arterial revascularization should be reserved to selected patients. Off-pump CABG, on-pump breathing heart CABG, and new cardioplegic solutions remain of uncertain benefit compared with traditional CABG. SUMMARY: Tremendous advancements in CABG allowed surgeons to offer revascularization to patients with severe left ventricular dysfunction and multivessel disease with acceptable risk. Despite that, there is a lack of comprehensive and robust studies particularly on long-term outcomes. Individualized patient assessment and a heart team approach should be used to determine the optimal surgical strategy for each patient.
Iacona et al. (2023) conducted a review in Left ventricular dysfunction requiring coronary artery bypass grafting. Coronary artery bypass grafting (CABG) was evaluated. Coronary artery bypass grafting in patients with severe left ventricular dysfunction can be performed with acceptable risk, though comprehensive studies on long-term outcomes are lacking.