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Updated: Aug 1, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Medium-term results of coronary artery bypass surgery in patients with severe left ventricular dysfunction and
1Department of Cardiac Surgery, Charles University Faculty of Medicine and Teaching Hospital, Hradec Králové.
Insights
Coronary artery bypass grafting (CABG) is safe for patients with severe left ventricular dysfunction and hibernating myocardium. Surgical revascularization improves cardiac function and clinical status, avoiding heart transplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Imaging
Background:
- Multivessel coronary artery disease (CAD) with severe left ventricular dysfunction (LVD) presents complex treatment challenges.
- Hibernating myocardium (HM), a state of reversible myocardial dysfunction, is a critical factor in surgical decision-making.
- Identifying HM preoperatively is essential for optimizing treatment strategies and patient outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary artery bypass grafting (CABG) in patients with multivessel CAD, severe LVD, and HM.
- To assess the impact of surgical revascularization on clinical status and left ventricular ejection fraction (LVEF).
- To determine if preoperative diagnosis of HM can prevent patients from being solely candidates for heart transplantation (HTX).
Main Methods:
- Retrospective analysis of patients with multivessel CAD, severe LVD, and confirmed HM.
- Surgical interventions included standard CABG with extracorporeal circulation (ECC), coronary endarterectomy (EAE), and minimally invasive direct coronary artery bypass grafting (MIDCAB) on a beating heart.
- Preoperative assessment included diagnostic methods to identify hibernating myocardium.
Main Results:
- CABG surgery in this patient cohort demonstrated low operative morbidity and mortality rates.
- Surgical revascularization significantly improved both the patient's clinical status and left ventricular ejection fraction (LVEF).
- Alternative surgical approaches like EAE and MIDCAB were safely performed without increasing operative mortality.
Conclusions:
- CABG is a safe and effective treatment for patients with multivessel CAD, severe LVD, and HM.
- Preoperative identification of HM is crucial, enabling more aggressive surgical strategies to salvage viable myocardium.
- Surgical revascularization improves cardiac function and clinical outcomes, potentially avoiding the need for heart transplantation.
Abstract:
In patients with multivessel coronary artery disease (CAD), severe left ventricular dysfunction (LVD) and hibernating myocardium (HM) demonstrated on preoperative assessment, coronary artery bypass grafting (CABG) surgery can be performed safely with low operative morbidity and mortality rates. Surgical revascularization of reversibly dysfunctional myocardium improves significantly both patient's clinical status and left ventricular ejection fraction (LVEF). Diagnosis of HM prior to CABG surgery seems to be crucial because it does not leave the patient with multivessel CAD and LVD a candidate only for heart transplantation (HTX). In the presence of HM, more aggressive surgical approach could be recommended to salvage chronically jeopardized but viable myocardium using not only routine CABG procedures in extracorporeal circulation (ECC) but also alternative approach of coronary endarterectomy (EAE) or minimally invasive direct coronary artery bypass grafting (MIDCAB) procedures on beating heart, without any adverse impact on operative mortality.
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