Our Summary

This research paper looks into the risks and potential benefits of a specific heart surgery technique for high-risk patients. The patients in question have a condition where the left side of their heart is not functioning properly and they have a low “ejection fraction” (EF), which means their heart isn’t pumping blood as well as it should be. This makes them more susceptible to complications and even death after undergoing a common heart surgery called coronary artery bypass grafting (CABG).

The paper discusses the authors’ experiences with a different version of this surgery, called “off-pump CABG,” which is done without stopping the heart and putting the patient on a heart-lung machine, as is done in a traditional CABG surgery. It’s not yet clear how successful this off-pump technique can be for high-risk patients with very low EF, so the authors share their strategies and planning process for performing this kind of surgery on such patients.

FAQs

  1. What risks do patients with left ventricular dysfunction and low ejection fraction face after undergoing coronary artery bypass grafting?
  2. How can off-pump CABG potentially benefit patients with very low ejection fraction?
  3. What strategies are used to perform off-pump CABG in patients with very low EF?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about CABG is to follow post-operative care instructions closely, including taking prescribed medications, attending follow-up appointments, and making lifestyle changes such as quitting smoking and maintaining a healthy diet and exercise routine. Following these recommendations can help improve the success of the surgery and reduce the risk of complications.

Suitable For

Patients who are typically recommended for CABG include those with:

  • Severe coronary artery disease
  • Left main coronary artery disease
  • Triple vessel disease
  • Patients who are not suitable candidates for percutaneous coronary intervention (PCI) or have failed previous PCI
  • Patients with left ventricular dysfunction and low ejection fraction (EF)
  • Patients with angina that is not controlled with medication
  • Patients with a history of heart attack or heart failure

Patients with left ventricular dysfunction and low ejection fraction are at high risk of complications and mortality after CABG, but the potential success of off-pump CABG in this high-risk population has yet to be illustrated. It is important for surgeons to carefully plan and strategize on how to perform off-pump CABG in these patients with very low EF to minimize risks and improve outcomes.

Timeline

Before CABG:

  1. Patient undergoes initial assessment and diagnosis of coronary artery disease.
  2. Patient may undergo preoperative tests such as angiography, stress tests, and echocardiograms to determine the extent of heart damage and the need for surgery.
  3. Patient may be placed on medications to stabilize their condition and reduce symptoms.
  4. Patient receives counseling and education on the CABG procedure, risks, and benefits.

After CABG:

  1. Patient undergoes surgery, where the surgeon creates new routes for blood flow to the heart using grafts from other vessels in the body.
  2. Patient is monitored closely in the intensive care unit (ICU) for any complications or signs of recovery.
  3. Patient may experience pain, discomfort, and fatigue in the days following surgery.
  4. Patient undergoes rehabilitation and recovery process, including physical therapy and lifestyle changes to improve heart health.
  5. Patient is followed up with regular check-ups and tests to monitor the success of the surgery and overall heart health.

What to Ask Your Doctor

  1. How will my left ventricular dysfunction and low ejection fraction impact the success and safety of the CABG procedure?
  2. What are the potential risks and complications associated with off-pump CABG in patients with very low EF?
  3. How will you determine if I am a suitable candidate for off-pump CABG versus traditional CABG with cardiopulmonary bypass?
  4. What specific measures will be taken during the surgery to address my low EF and minimize the risk of complications?
  5. How will my recovery and long-term outcomes differ between off-pump CABG and traditional CABG in my specific case?
  6. What is the expected timeline for my recovery and when can I expect to resume normal activities after the procedure?
  7. Are there any lifestyle changes or medications I should consider after the surgery to improve my heart health and reduce the risk of future complications?
  8. How frequently will I need follow-up appointments and monitoring after the CABG procedure, and what signs or symptoms should I watch for that may indicate a problem?
  9. Are there any additional tests or procedures that may be necessary to assess my heart function and overall health before and after the CABG surgery?
  10. Are there any alternative treatments or interventions that may be considered for my condition, and how do they compare to off-pump CABG in terms of effectiveness and safety?

Reference

Authors: Magarakis M, Buitrago DH, Macias AE, Tompkins BA, Salerno TA. Journal: J Card Surg. 2021 Mar;36(3):1067-1071. doi: 10.1111/jocs.15330. Epub 2021 Jan 21. PMID: 33476419