Purpose of Review: This review aims to evaluate the outcomes of Coronary Artery Bypass Grafting (CABG) in patients with low ejection fraction (EF), focusing on both short-term and long-term considerations. It seeks to address the perioperative risks, potential benefits, and the impact of various surgical techniques and management strategies on patient outcomes. Recent Findings: Patients with low EF undergoing CABG are at an increased risk of perioperative complications, including higher mortality and morbidity rates compared to those with preserved EF. However, advancements in surgical techniques, such as off-pump CABG, have been associated with improved outcomes in this high-risk group. For instance, a study comparing on-pump and off-pump CABG in patients with severe left ventricular dysfunction found that the off-pump approach was associated with reduced incidences of acute kidney injury, delirium, and sepsis, as well as shorter ICU stays and mechanical ventilation durations. Additionally, long-term studies have demonstrated that CABG can lead to improved survival and quality of life in patients with reduced EF. A retrospective cohort study reported that patients with severely reduced left ventricular ejection fraction undergoing CABG had better long-term outcomes compared to those undergoing percutaneous coronary intervention (PCI). Summary: Despite the elevated perioperative risks, CABG remains a viable and often preferred revascularization strategy for patients with low EF, offering significant long-term benefits such as enhanced survival and quality of life. The choice of surgical technique, particularly the use of off-pump CABG, along with comprehensive preoperative assessment and meticulous postoperative care, are crucial in optimizing outcomes for this high-risk population. These findings underscore the importance of individualized patient evaluation and the implementation of advanced surgical and perioperative strategies to improve both short-term and long-term results in patients with low EF undergoing CABG.
