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[Medium- and long-term outcomes of cardiac assist devices after coronary artery bypass grafting in left ventricular

L X Zhao1, J Zhang1, D H Liu1

  • 1Department of Cardiovascular Sugery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.

Zhonghua Yi Xue Za Zhi
|May 13, 2020
PubMed

Insights

Patients with left ventricular dysfunction undergoing coronary artery bypass grafting (CABG) often require cardiac assist devices like intra-aortic balloon pumps (IABP) and extracorporeal membrane oxygenation (ECMO). Despite higher device use and mortality, optimal management leads to good medium- and long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Assist Devices
  • Left Ventricular Dysfunction

Background:

  • Left ventricular dysfunction (LVEF ≤40%) poses challenges during coronary artery bypass grafting (CABG).
  • Cardiac assist devices, including intra-aortic balloon pumps (IABP) and extracorporeal membrane oxygenation (ECMO), may be necessary for these high-risk patients.

Purpose of the Study:

  • To evaluate the medium- and long-term outcomes of cardiac assist devices in patients undergoing CABG with left ventricular dysfunction.
  • To compare the use of IABP and ECMO and associated outcomes in patients with and without left ventricular dysfunction.

Main Methods:

  • A retrospective analysis of 127 patients with LVEF ≤40% undergoing CABG, compared to 2,454 controls with LVEF >55%.
  • Data on IABP and ECMO application, Intensive Care Unit (ICU) and hospital stay, and mortality were collected and analyzed.
  • Follow-up assessments of left ventricular ejection fraction (LVEF) were conducted at 3, 6 months, and annually thereafter.

Main Results:

  • Patients with left ventricular dysfunction showed significantly higher rates of IABP (10.2% vs 0.8%) and ECMO (6.3% vs 0.3%) usage compared to controls.
  • Mortality was higher in the left ventricular dysfunction group (4.7% vs 0.7%), along with longer ICU and hospital stays.
  • In the left ventricular dysfunction group, LVEF improved post-surgery, reaching (48±8)% at 3 months, (51±9)% at 6 months, and (55±9)% at 1 year, with stable maintenance thereafter.

Conclusions:

  • Despite a high requirement for cardiac assist devices, patients with left ventricular dysfunction undergoing CABG can achieve favorable medium- and long-term outcomes with optimal perioperative management.
  • The findings support the recommendation of cardiac assist devices in clinical practice for selected patients with left ventricular dysfunction undergoing CABG.

Keywords:
Coronary artery bypassHeart-assist devicesVentricular dysfunction, left

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