CONGRESS ABSTRACT

Introduction: Reduced left ventricle ejection fraction (LVEF) identifies a frail, high-risk population undergoing coronary artery by-pass grafting (CABG) whose benefit remains debated. We assessed the impact of baseline ventricular dysfunction on early outcomes, long-term prognosis, and ventricular function recovery after isolated CABG. Methods: Retrospective single-center study of 2230 consecutive patients undergoing isolated CABG (2017–2024). Patients were stratified by baseline LVEF: ≤35%, 36–49%, ≥50%. Early postoperative outcomes, complications, and rescue after complications were recorded. Survival and cardiovascular rehospitalization were assessed using Kaplan–Meier analysis; predictors were identified by Cox regression. Recovery of ventricular function was evaluated in 1092 survivors with follow-up echocardiography (ΔLVEF). Results: Patients with lower LVEF had a higher baseline comorbidity burden (diabetes 46%, CKD 29%, COPD 21%, NYHA ≥III 52%) and more frequent urgent presentation (41%). Postoperative complications were more common in reduced LVEF: respiratory failure (5.8%), atrial fibrillation (25.2%), sepsis (1.8%), and transient neurologic deficits (8.4%), with longer ICU and hospital stay. In-hospital mortality was low (0.6%) and did not differ significantly across LVEF groups. At follow-up, patients with LVEF ≤35% showed lower 8-year survival (55%) and lower freedom from cardiovascular rehospitalization (34%) (log-rank p<0.001). At multivariable analysis, advanced age, diabetes, renal failure, COPD, NYHA class ≥III, acute coronary syndrome, and major postoperative complications were independent predictors of mortality. LVEF recovery was assessable in 1092 survivors; improvement occurred in ~88% of those with LVEF ≤35%, with a mean LVEF increase of +14.0 percentage points (p<0.001). Conclusions: CABG can be safely performed in patients with reduced LVEF, with very low operative mortality. Although reduced baseline LVEF remains associated with worse long-term outcomes, surgical revascularization yields substantial recovery of ventricular function in most patients with severe dysfunction, supporting surgical revascularization in ischemic cardiomyopathy.