Coronary artery bypass grafting in left ventricular dysfunction: when and how
Gabriele M Iacona1, Jules J Bakhos, Michael Z Tong
1Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Current Opinion in Cardiology
|September 26, 2023
Summary
Coronary artery bypass grafting (CABG) for patients with low ejection fraction requires careful surgical management. This review covers current evidence and best practices for optimizing outcomes in these high-risk individuals.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Background:
- Coronary artery bypass grafting (CABG) in patients with low ejection fraction presents significant perioperative risks, including postcardiotomy shock.
- Preoperative optimization, potentially including mechanical support, is crucial for patients with cardiogenic shock.
Approach:
- This review synthesizes the latest evidence and best practices for surgical management of CABG in patients with reduced ejection fraction.
- It emphasizes the importance of rapid and complete revascularization.
- The role of multiple arterial revascularization and alternative CABG techniques (off-pump, beating heart) is discussed with respect to their uncertain benefits.
Key Points:
- Advancements in CABG enable revascularization for patients with severe left ventricular dysfunction and multivessel disease.
- Despite progress, robust long-term outcome data are lacking.
- Individualized assessment and a heart team approach are essential for determining optimal surgical strategies.
Conclusions:
- Surgical management of CABG in low ejection fraction patients demands meticulous technique and judgment.
- A multidisciplinary heart team approach is vital for personalized treatment strategies.
- Further research is needed to fully elucidate long-term outcomes of modern CABG techniques in this population.
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