Background: This study evaluates the outcomes of conventional cardiac surgery in patients with a left ventricular ejection fraction (LVEF) of 25% or less.
Methods: Patients with preoperative low LVEF (25% or less) undergoing The Society of Thoracic Surgeons (STS) indexed cardiac operations from 2010 to 2018 were included. The primary outcome was survival. Secondary outcomes included major postoperative complications and readmission rates. Multivariable Cox regression was utilized for risk adjustment. Subanalyses evaluated the effect of preoperative inotropes as well as the impact of low LVEF on survival and readmission compared with propensity matched patients with LVEF greater than 25%.
Results: In all, 9467 patients underwent STS-indexed cardiac operations during the study period, including 588 with LVEF of 25% or less. The low LVEF group included 397 (67.5%) isolated coronary artery bypass graft, 51 (8.67%) isolated valve, and 140 (23.8%) concomitant coronary artery bypass graft and valve operations. Survival of low LVEF patients was not affected by operative procedure but instead by traditional risk factors such as advanced age and medical comorbidities. Freedom from hospital readmission for heart failure was 57.2% at 5-year follow-up. Patients receiving preoperative inotropes had reduced survival, although the majority were still alive at 5 years (53.1% vs 64.9%, P = .002). In addition, propensity matched patients with LVEF 25% or less and LVEF greater than 25% had similar survival and hazards for mortality at 30-day, 1-year, and 5-year follow-up.
Conclusions: Despite a high-risk profile, patients with reduced preoperative LVEF can undergo conventional cardiac surgery with acceptable outcomes. The majority of patients, including those receiving preoperative inotropes, were alive and free from heart failure readmissions at 5 years.
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