OUTCOMES OF CORONARY ARTERY BYPASS GRAFTING IN PATIENTS WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION: A SINGLE-CENTER RETROSPECTIVE ANALYSIS

Hasan Al Imran, Wei Wang*

ABSTRACT

Background: Coronary artery bypass grafting (CABG) remains the preferred revascularization strategy for patients with complex coronary artery disease, particularly those with reduced left ventricular ejection fraction (LVEF). However, patients with LVEF < 50% present unique surgical challenges and are associated with higher perioperative morbidity and mortality. This study aimed to evaluate the effectiveness and safety of CABG in patients with reduced LVEF compared to those with preserved systolic function. Methods: A retrospective analysis was conducted on 248 patients who underwent CABG between January 2022 and December 2025. Patients were divided into two groups: reduced ejection fraction group (LVEF < 50%, n=118) and preserved ejection fraction group (LVEF ≥ 50%, n=130). Perioperative outcomes, including mortality, intra-aortic balloon pump (IABP) implantation rates, and postoperative complications, were compared between groups. Results: Patients in the reduced ejection fraction group presented with significantly higher proportions of prior myocardial infarction (16.9% vs. 3.8%), ventricular aneurysm (4.2% vs. 0%), and mitral regurgitation (4.2% vs. 0%) (P < 0.05). In-hospital mortality was significantly higher in the reduced ejection fraction group (2.5% vs. 0.8%, P < 0.05), as was the rate of IABP implantation (33.1% vs. 10.8%, P < 0.001). No significant differences were observed between groups regarding hospital stay, number of distal anastomoses, postoperative drainage volume, or wound infection rates (P > 0.05). Conclusions: Reduced LVEF significantly increases the risk and technical complexity of CABG, with higher mortality and IABP utilization rates. However, with appropriate perioperative management, including meticulous surgical technique, optimal myocardial protection, and proactive circulatory support, acceptable outcomes can be achieved in this high-risk patient population.

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