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Updated: Apr 4, 2026
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
[Efficacy of Multi-vessel Coronary Artery Bypass Grafting for Patient with Low Left Ventricular Ejection Fraction]
Toshihito Yoshida1, Tatsuya Seki
1Department of Cardiovascular Surgery, Japan Community Health Care Organization, Hokkaido Hospital, Sapporo, Japan.
Insights
Multi-vessel coronary artery bypass grafting (CABG) with 6 or more distal anastomoses safely improves left ventricular ejection fraction (LVEF) in patients with low LVEF compared to fewer anastomoses. This approach demonstrates superior LVEF recovery without compromising graft patency.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Revascularization
Context:
- The efficacy of multi-vessel coronary artery bypass grafting (CABG) in patients with low left ventricular ejection fraction (LVEF) remains a subject of debate.
- Assessing surgical strategies for improving cardiac function in compromised ventricles is critical.
Purpose:
- To evaluate the safety and efficacy of performing a higher number of distal anastomoses during multi-vessel CABG in patients with low LVEF.
- To compare the impact of CABG with ≥6 distal anastomoses versus ≤5 distal anastomoses on postoperative LVEF and graft patency.
Summary:
- A study of 31 low LVEF patients undergoing CABG found no operative mortality.
- Patients undergoing CABG with ≥6 distal anastomoses (group B) showed significantly greater improvement in LVEF compared to those with ≤5 anastomoses (group A) (9.3% vs 4.6%, p=0.023).
- A higher percentage of patients in group B experienced >5% LVEF improvement (78.6% vs 29.4%, p=0.006), with excellent early and comparable long-term graft patency in both groups.
Impact:
- Multi-vessel CABG with 6 or more distal anastomoses can be safely performed in low LVEF patients.
- This strategy leads to superior LVEF improvement compared to CABG with fewer anastomoses.
- The findings support an aggressive surgical approach for myocardial revascularization in selected low LVEF patients.
Abstract:
The efficacy of multi-vessel coronary artery bypass grafting (CABG) for low left ventricular ejection fraction (LVEF) is controversial. We assessed 31 consecutive low LVEF patients who underwent CABG in our hospital from April 2007 to September 2014. Seventeen patients underwent CABG with distal anastomosis 5 or less (group A), and 14 patients underwent CABG with distal anastomosis 6 or more (group B). Twenty-eight (90%)patients underwent off-pump CABG, and 3 (10%) patients underwent on-pump beating CABG. There was no operative mortality. Postoperative LVEF was improved in group B more than that in group A [9.3±7.0% vs 4.6±9.0% (p=0.023)]. The percentage of patients with improvement of LVEF more than 5% was higher in group B [group A vs group B=29.4% vs 78.6%(p=0.006)]. Early patency rate was 100% (137/137 anastomoses), and cumulative patency rate was not different between 2 groups [group A (1 year:100%, 3 year:100%, 5 year:100%), group B (1 year:100%, 3 year:94.8%, 5 year:94.8%).p=0.177]. The multi-vessel CABG (6 or more distal anastomoses) could be performed safely and would improve LVEF more than less number vessel CABG( 5 or less distal anastomoses) in low LVEF patients.
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