Our Summary

The paper is about a study done on patients with advanced heart failure who underwent a specific type of heart surgery. The surgery is the implantation of a device known as a left ventricular assist device (LVAD). Some of these patients also underwent another type of surgery called coronary artery bypass grafting (CABG) at the same time. The researchers wanted to understand the effects of having both these surgeries at the same time.

They studied patients who had these surgeries between 2010 and 2016. They divided the patients into two groups, one group had both surgeries (CABG group) and the other group only had the LVAD implantation (non-CABG group).

The study found no significant difference in the baseline characteristics between the two groups. However, the CABG group took a bit longer to recover from surgery. More importantly, the survival rate one month after surgery was significantly lower for the CABG group compared to the non-CABG group.

There was no difference between the two groups in terms of the occurrence of irregular heart rhythms or failure of the right side of the heart.

The researchers concluded that having both surgeries at the same time may increase the risk of death after surgery, and hence, the combination of CABG with LVAD surgery should only be done in select cases after careful consideration.

FAQs

  1. What is the impact of concomitant coronary artery bypass grafting (CABG) during LVAD implantation on patient survival rates?
  2. Is there a difference in the occurrence of ventricular arrhythmias or right ventricular failure between patients who had CABG during LVAD implantation and those who did not?
  3. Should CABG surgery be performed in conjunction with LVAD implantation in all cases, or only in specific, select cases?

Doctor’s Tip

A doctor might tell a patient considering heart bypass surgery to carefully weigh the risks and benefits of having concomitant coronary artery bypass grafting (CABG) during left ventricular assist device (LVAD) implantation. It is important to understand that undergoing both procedures simultaneously may increase the risk of complications and potentially impact survival rates in the short term. Therefore, the decision to include CABG during LVAD implantation should be made based on individual patient characteristics and carefully considered in consultation with a healthcare provider.

Suitable For

Patients who are typically recommended heart bypass surgery are those with advanced heart failure due to ischemic cardiomyopathy. In particular, patients who are undergoing left ventricular assist device (LVAD) implantation may be considered for concomitant coronary artery bypass grafting (CABG) if they have significant coronary artery disease. However, the decision to perform concomitant CABG during LVAD implantation should be made on a case-by-case basis, as there may be increased perioperative mortality associated with this combined surgical approach. It is important to carefully select patients for concomitant CABG during LVAD implantation to optimize outcomes.

Timeline

Before heart bypass surgery, a patient may experience symptoms of coronary artery disease such as chest pain (angina), shortness of breath, fatigue, or other symptoms related to heart failure. They may undergo diagnostic tests such as a coronary angiogram to determine the extent of blockages in their coronary arteries.

During heart bypass surgery, the patient is placed under general anesthesia and a heart-lung machine is used to pump blood and oxygen throughout the body while the heart is stopped. The surgeon then takes a healthy blood vessel from another part of the body (such as the leg or chest) and uses it to bypass the blocked coronary artery, allowing blood to flow freely to the heart muscle.

After heart bypass surgery, the patient will typically spend a few days in the hospital recovering. They may experience pain at the incision site, fatigue, and difficulty breathing. Physical therapy and a cardiac rehabilitation program may be recommended to help with recovery and improve cardiovascular health. The patient will also need to make lifestyle changes such as quitting smoking, eating a healthy diet, and exercising regularly to prevent further heart problems.

What to Ask Your Doctor

  1. What are the potential risks and benefits of undergoing concomitant coronary artery bypass grafting (CABG) during left ventricular assist device (LVAD) implantation?

  2. How will having CABG during LVAD implantation impact my recovery time and overall prognosis?

  3. What criteria are used to determine if a patient is a good candidate for concomitant CABG during LVAD implantation?

  4. How will having CABG during LVAD implantation affect my long-term management and follow-up care?

  5. Are there any alternative treatment options or approaches that could be considered instead of undergoing concomitant CABG during LVAD implantation?

  6. Will having CABG during LVAD implantation increase the likelihood of complications or adverse events during or after the surgery?

  7. How experienced is the surgical team in performing concomitant CABG during LVAD implantation, and what is their success rate with this combined surgical approach?

  8. What are the potential implications for my quality of life and daily activities if I undergo concomitant CABG during LVAD implantation?

  9. Are there any specific lifestyle changes or precautions I should take if I undergo concomitant CABG during LVAD implantation to optimize my recovery and overall health?

Reference

Authors: Mehta P, Imamura T, Juricek C, Sarswat N, Kim G, Raikhelkar J, Song T, Ota T, Jeevanandam V, Sayer G, Uriel N. Journal: ASAIO J. 2020 Jan;66(1):32-37. doi: 10.1097/MAT.0000000000000956. PMID: 31294723