Propensity score-based comparison of high-risk coronary artery bypass grafting vs. left ventricular assist device implantation in patients with coronary artery disease and advanced heart failure

Objectives Revascularization in patients with severely reduced left ventricular function and coronary artery disease (CAD) is associated with a high perioperative risk. In this setting, implantation of a durable left ventricular assist device (LVAD) might be an alternative. Methods We retrospectively compared the outcomes of adult patients with CAD and a left ventricular ejection fraction (LVEF) ≤ 25% who underwent coronary artery bypass grafting (CABG) vs. LVAD implantation. Propensity score (PS) matching was performed for statistical analysis, resulting in 168 pairs. Results In the PS-matched cohorts, the mean age was 62 years; one third had a history of myocardial infarction, 11% were resuscitated, half of the patients were on inotropic support, and 20% received preoperative mechanical circulatory support. LVAD patients required significantly longer ventilation (58 h 21, 256 vs. 16 h 9, 73, p 0.001) and had a longer ICU stay (11d 7, 24 vs. 4d 2, 10, p ≤ 0.001) compared to CABG patients The incidence of postoperative renal replacement therapy (2 1.2% vs.15 8.9%, p = 0.002) and temporary mechanical circulatory support was lower in the LVAD group (1 0.6% vs. 51 30.4%, p ≤ 0.001). The in-hospital stroke rate was similar (LVAD 7 5.4% vs. CABG 8 6.2%, p = 0.9). In-hospital survival, 1-year survival, and 3-year survival were 90.5% vs. 85.5% ( p = 0.18), 77.4% vs. 68.9% ( p = 0.10) and 69.6% vs. 45.9% ( p 0.001), for CABG and LVAD patients respectively. Conclusion Patients with CAD and advanced HF demonstrate better mid-term survival if they undergo CABG rather than LVAD implantation.