Related Experiment Video
Updated: Jan 17, 2026
16:11
Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
36.0K
Total-Arterial Revascularization Is Superior in Heart Failure Patients with Reduced Ejection Fraction-A Propensity
Christian Jörg Rustenbach1, Julia Schano1, Christoph Salewski1
1Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany.
Medical Sciences (Basel, Switzerland)
|September 22, 2025
Summary
Total arterial revascularization (TAR) significantly lowers major adverse cardiac and cerebrovascular events (MACCE) and improves perioperative outcomes in heart failure with reduced ejection fraction (HFrEF) patients undergoing coronary artery bypass grafting (CABG). Further research is needed to confirm long-term benefits.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF) present significant clinical challenges.
- Total arterial revascularization (TAR) is a surgical strategy that may offer improved outcomes in these patients.
Purpose of the Study:
- To evaluate the efficacy and safety of TAR compared to non-total arterial revascularization (NTAR) in patients with HFrEF undergoing coronary artery bypass grafting (CABG).
Main Methods:
- A retrospective analysis of 574 adult patients with HFrEF (LVEF < 40%) undergoing isolated CABG between 2017 and 2023 across four German centers.
- Propensity score matching created a cohort of 240 patients (120 TAR vs. 120 NTAR) for comparative analysis.
- Primary endpoint: in-hospital Major Adverse Cardiac and Cerebrovascular Events (MACCE). Secondary endpoints included ICU/hospital length-of-stay, ventilation time, delirium, and transfusion requirements.
Main Results:
- TAR group showed significantly lower in-hospital MACCE rates (4.1% vs. 14.2%, p=0.007) compared to NTAR.
- Patients undergoing TAR experienced shorter ICU stays (44.5h vs. 90h), hospital stays (10d vs. 12d), and reduced ventilation times (8h vs. 12h).
- TAR was associated with lower incidence of delirium (5.0% vs. 14.2%) and reduced red blood cell (RBC) transfusion requirements.
Conclusions:
- In this propensity-matched cohort, TAR demonstrated superior perioperative outcomes and reduced MACCE compared to NTAR in HFrEF patients.
- The findings suggest TAR as a potentially beneficial revascularization strategy for HFrEF patients.
- Prospective studies are recommended to confirm causality and long-term benefits of TAR.
