Mechanical Circulatory Support During Surgical Revascularization for Ischemic Cardiomyopathy

Area of Science:

• Cardiology
• Cardiac Surgery
• Mechanical Circulatory Support

Background:

• Ischemic cardiomyopathy poses challenges for surgical revascularization.
• Mechanical circulatory support (MCS) is increasingly considered for high-risk cardiac surgery patients.

Purpose of the Study:

• To evaluate the utilization and outcomes of perioperative mechanical circulatory support (MCS) in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (CABG).

Main Methods:

• Retrospective analysis of 378 patients with ejection fraction <35% undergoing isolated CABG (2015-2021).
• Patients categorized into no MCS, preoperative MCS, or postoperative MCS groups.
• Primary outcome: operative mortality. Secondary outcomes: 3-year survival.

Main Results:

• Overall operative mortality was 3.4%, with 3-year survival at 87.0%.
• Preoperative MCS (n=31) showed no significant difference in operative mortality (7.7% vs 2.9%) or long-term survival compared to no MCS.
• Postoperative MCS (n=30) was associated with significantly increased operative (16.7%) and late mortality (63%).

Conclusions:

• Selective perioperative MCS use is safe for CABG in ischemic cardiomyopathy.
• Preoperative MCS is associated with acceptable short- and long-term survival despite disease severity.
• Postoperative MCS use indicates increased morbidity and mortality risk.