Coronary artery bypass grafting in low ejection fraction: state of the art. (November 2021)

• Record Type: Journal Article
• Authors: Robinson, N. Bryce; Audisio, Katia; Bakaeen, Faisal G.; Gaudino, Mario
• Is Part Of: Current opinion in cardiology. Volume 36:Number 6(2021)
• Publication Date: 2021-11
• Subjects: coronary artery bypass grafting -- ejection fraction -- multiple arterial grafting; Cardiology -- Periodicals; Cardiology -- Periodicals; Heart Diseases -- Periodicals; Cardiology; Periodicals; 616.12
• DOI: 10.1097/HCO.0000000000000908
• Languages: English
• ISSNs: 0268-4705

Abstract

Abstract : Purpose of review: As the number of patients with reduced ejection fraction secondary to ischemic cardiomyopathy (ICM) increases, coronary artery bypass grafting is being used with increasing frequency. In this review, we summarize the different operative considerations in this vulnerable patient population. Recent findings: Preoperative optimization with mechanical circulatory support devices, especially in the setting of hemodynamic instability, can reduce perioperative morbidity and mortality. The advantage of advanced techniques, such as off-pump CABG and multiple arterial grafting remains unclear. Concomitant procedures, such as ablation for atrial fibrillation remain important considerations that should be tailored to the individual patients risk profile. Summary: Despite improvements in perioperative care of patients undergoing CABG, patients with a reduced ejection fraction remain at elevated risk of major morbidity and mortality. Preoperative optimization and careful selection of intraoperative techniques can lead to improved outcomes.