Coronary artery bypass grafting in patients with advanced left ventricular dysfunction

Area of Science:

• Cardiology
• Cardiac Surgery
• Vascular Medicine

Background:

• Coronary artery disease (CAD) with reduced ejection fraction (EF) presents unique challenges for surgical intervention.
• Long-term outcomes of coronary artery bypass grafting (CABG) in patients with sequentially decreased EF require detailed investigation.

Purpose of the Study:

• To evaluate long-term survival and angina control in patients with CAD and reduced EF undergoing first-time CABG.
• To identify predictors of mortality and symptom recurrence in this patient cohort.

Main Methods:

• A retrospective analysis of 11,840 patients undergoing CABG between 1981 and 1995, categorized by EF (<0.25, 0.25-0.34, 0.35-0.49, ≥0.50).
• Comparison of clinical characteristics, operative data, and outcomes including survival, angina incidence, and mortality.
• Multivariate analysis to determine correlates of early and long-term mortality and angina at follow-up.

Main Results:

• Patients with lower EF had higher rates of comorbidities and complex coronary disease.
• Hospital mortality was higher in groups with lower EF (1.6% to 3.8%).
• Long-term survival was significantly lower in patients with EF <0.50 (p < 0.0001), though >60% of those with EF <0.25 survived 5 years.
• Angina control was similar across EF groups (31%–40% vs. 33%).
• Key predictors of mortality included advanced age, female sex, low EF, hypertension, diabetes, and emergency operation.

Conclusions:

• Despite higher long-term mortality, CABG in selected patients with reduced EF and ischemia can preserve myocardium and provide symptom relief.
• Survival exceeding 60% at 5 years is achievable in patients with EF <0.25.
• Preexisting conditions and incomplete revascularization significantly influence long-term survival and symptom control post-CABG.