Perioperative changes in left ventricular systolic function following surgical revascularization

Michael Downey, Matthew C Hooks, Amy A Gravely, Niyada Naksuk, Melissa Buelt-Gebhardt, Selma Carlson, Venkat Tholakanahalli, Selçuk Adabag

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1 Scopus citations


Background Nearly 1/3rd of patients undergoing coronary artery bypass graft surgery (CABG) have left ventricular systolic dysfunction. However, the extent, direction and implications of perioperative changes in left ventricular ejection fraction (LVEF) have not been well characterized in these patients. Methods We studied the changes in LVEF among 549 patients with left ventricular systolic dysfunction (LVEF <50%) who underwent CABG as part of the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Patients had pre- and post-CABG (4 month) LVEF assessments using identical cardiac imaging modality, interpreted at a core laboratory. An absolute change of >10% in LVEF was considered clinically significant. Results Of the 549 patients (mean age 61.4±9.55 years, and 72 [13.1%] women), 145 (26.4%) had a >10% improvement in LVEF, 369 (67.2%) had no change and 35 (6.4%) had >10% worsening of LVEF following CABG. Patients with lower preoperative LVEF were more likely to experience an improvement after CABG (odds ratio 1.36; 95% CI 1.21–1.53; per 5% lower preoperative LVEF; p <0.001). Notably, incidence of postoperative improvement in LVEF was not influenced by presence, nor absence, of myocardial viability (25.5% vs. 28.3% respectively, p = 0.67). After adjusting for age, sex, baseline LVEF, and NYHA Class, a >10% improvement in LVEF after CABG was associated with a 57% lower risk of all-cause mortality (HR: 0.43, 95% CI: 0.26–0.71). Conclusions Among patients with ischemic cardiomyopathy undergoing CABG, 26.4% had >10% improvement in LVEF. An improvement in LVEF was more likely in patients with lower preoperative LVEF and was associated with improved long-term survival.

Original languageEnglish (US)
Article numbere0277454
JournalPloS one
Issue number11 November
StatePublished - Nov 2022

Bibliographical note

Funding Information:
SA received an education grant from Medtronic ( index.html) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.


  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Coronary Artery Bypass/adverse effects
  • Myocardial Ischemia/complications
  • Stroke Volume
  • Treatment Outcome
  • Ventricular Dysfunction, Left/etiology
  • Ventricular Function, Left
  • Clinical Trials as Topic

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article


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