Graft Strategy for Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Outcomes
• Graft Selection

Background:

• Optimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction is debated.
• This study analyzes outcomes of isolated CABG in patients with severe LV dysfunction (ejection fraction [EF] <30%).

Purpose of the Study:

• To evaluate the impact of graft strategy on long-term outcomes in patients with severe LV dysfunction undergoing CABG.
• To compare outcomes between bilateral internal thoracic arterial (BITA) grafts and single internal thoracic arterial (SITA) grafts.

Main Methods:

• Analysis of 209 patients with severe LV dysfunction undergoing primary isolated CABG.
• Patients were revascularized with either bilateral ITA grafts (BITA group, n=169) or single ITA grafts (SITA group, n=40).
• Mean follow-up duration was 22±32 months, with assessment of overall survival and freedom from cardiac-related death.

Main Results:

• Overall survival at 5 years was 66.7%, with 18 early deaths (8.6%).
• Freedom from cardiac-related death at 5 years was 74.1% and significantly higher in off-pump CABG and BITA groups (p=0.005, p=0.023).
• Multivariate analysis identified old age as a risk factor for cardiac mortality, while off-pump CABG and BITA grafts were protective (HR, 0.245; p=0.006 and HR, 0.333; p=0.009, respectively).

Conclusions:

• Coronary artery bypass grafting in patients with severe LV dysfunction yields reasonable long-term results.
• Off-pump CABG and bilateral ITA grafting are associated with a significantly higher rate of freedom from cardiac-related death.
• Off-pump BITA grafting is a viable primary option for severe LV dysfunction patients when performed by experienced surgeons.