Short Term Outcomes of Total Arterial Revascularization in Patients with LV Dysfunction-A Retrospective Study

Kumar L and Priya K

Published on: 2025-10-07

Abstract

Background

Coronary artery bypass surgery (CABG) is the choice of treatment for patients with Multi vessel coronary artery disease (MV CAD). Left ventricular dysfunction is one of the commonest complications in patients with multi-vessel CAD which can increase the risk of adverse events in the intra-operative and postoperative period. Therefore optimisation of surgical techniques in order to enhance the outcomes in patients with LV dysfunction is of utmost importance.

With the advances in surgical techniques and constant desire for better long term outcomes, multiple arterial conduits and TAR techniques are being increasingly used. Many studies have showed that arterial conduits have various benefits such as long term patency, reduced mortality, reduced cerebro vascular events, reduced need for redo revascularization.

This study aims in analysing the short term outcomes of total arterial revascularization in patients with left ventricular dysfunction and to compare the outcomes with patients undergoing total arterial revascularization with normal left ventricular functions.

Keywords

Coronary artery; Arterial revascularization; Surgical techniques

Objective

This retrospective study assessed short-term outcomes of total arterial revascularization in patients with LV dysfunction and compared them with patients having normal LV function.

Methods

Conducted at Apollo Hospitals, Chennai, between September 2023 and December 2024, the study included 81 patients undergoing open CABG with TAR (31 with LV dysfunction, 50 with normal LV function).

Demographic, clinical, intraoperative, and postoperative variables were analyzed.

Summary statistics were presented with Mean ± SD and frequency (Percentage) for the continuous and categorical factors respectively. Student’s t-test/Mann Whitney U test was used to determine the significant changes between two independent factors. Chi-square/Fisher’s exact test was used to determine the association between two independent categorical factors. Paired Sample t-test was used to determine the significant changes in the Ejection fraction between Pre and Post-operative visits. P-value < 0.05 consider as statistical significance. All the statistics was computed by using SPSS (IBM, 28.0).

Results

Baseline demographics were comparable between groups. Patients with LV dysfunction had significantly higher rates of insulin-dependent diabetes (p = 0.006), renal impairment (p < 0.001), and recent myocardial infarction (p = 0.002). LV dysfunction patients were more frequently in acritical preoperative state (p = 0.019) [1-3].

Figure 1: Comorbidities.

Postoperatively, they had longer ICU stays (3.94 +/- 1.29 vs. 3.38 +/- 0.73 days, p = 0.015). Mean ejection fraction improved modestly but significantly in the LV dysfunction group (pre-op: 39.39 +/- 6.73% vs. post-op: 43.16 +/- 6.56%, p =0.047). Mortality occurred in 1 patient (3.2%) with LV dysfunction, whereas no deaths were recorded in the normal LV group [4].

Figure 2: Ejection Fraction.

Other postoperative complications such as arrhythmias, wound infection, and re-exploration showed no significant difference [5-6].

Conclusion

Total arterial revascularization in patients with LV dysfunction is feasible and associated with acceptable short-term outcomes. Although ICU stay and perioperative risk were higher, patients demonstrated significant postoperative improvement in ejection fraction with low mortality.

These findings support TAR as a safe strategy even in high-risk LV dysfunction populations, warranting further long-term outcome studies.

References

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