Coronary Artery Bypass Graft Surgery in Patients with Impaired Left Ventricular Function

Abstract

In last, we can summaries the following results regarding CABG in patients with impaired LV function: Ischemic heart disease is a major health problem; it is the result of an imbalance between myocardial oxygen supply and demand. Coronary atherosclerosis is the dominant underlying cause of ischemic heart disease. In the last several decades the number of the patients with impaired left ventricular ejection fraction (EF) due to ischemic heart disease has increased as a result of progressively aging population and expanded and repeated usage of PCI in coronary revascularization and delayed surgical option. Despite improvements in medical therapies and surgical techniques, the management of patients with IHD with impaired LV function is still challenging. CABG has shown to be superior to medical therapy alone for low EF patients. Although in these patients, CABG is reported to be associated with high perioperative mortality and many patients may require inotropic or mechanical support for hours to days after surgery, advances in surgical techniques, myocardial protection, and perioperative anesthesiology management have continuously leading to improved outcomes, studies have reported good initial and mid-term results. Low EF alone should not be used as a criterion to turn patients away from CABG surgery. The aim of CABG patients with impaired LV function is: (1) To correct myocardial ischemia and hence prevent further adverse ventricular remodeling and myocardial infarction. (2) To improve myocardial contractility in regions of hibernating myocardium that have been shown to be viable. There is a strong association between CABG and improved survival among patients with CAD and significant LV dysfunction who have evidence of myocardial viability on imaging tests. The likelihood of improved survival was greatest in patients with demonstrated viability and the most severe LV dysfunction.