Coronary artery bypass grafting in low ejection fraction: state of the art

Area of Science:

• Cardiovascular Surgery
• Cardiology
• Cardiac Surgery

Background:

• Increasing prevalence of reduced ejection fraction secondary to ischemic cardiomyopathy (ICM).
• Coronary artery bypass grafting (CABG) is frequently employed in this patient demographic.
• Patients with reduced ejection fraction represent a vulnerable population undergoing CABG.

Purpose of the Study:

• To review operative considerations for CABG in patients with reduced ejection fraction due to ICM.
• To summarize current strategies for managing this high-risk patient group.

Main Methods:

• Review of current literature and clinical practices.
• Discussion of preoperative optimization strategies.
• Analysis of intraoperative techniques and concomitant procedures.

Main Results:

• Preoperative optimization, including mechanical circulatory support for hemodynamic instability, can mitigate perioperative risks.
• The benefits of advanced techniques like off-pump CABG and multiple arterial grafting require further clarification.
• Concomitant procedures, such as atrial fibrillation ablation, should be individualized based on patient risk.

Conclusions:

• Patients with reduced ejection fraction undergoing CABG remain at elevated risk despite perioperative care improvements.
• Preoperative optimization and judicious selection of intraoperative techniques are crucial for enhancing outcomes in ICM patients.
• Tailored surgical approaches are essential for managing this complex patient population.