cabg in lv dysfunction recent trends.pptx

recent trends of cabg in lv dysfunction

1. CABG in severe LV dysfunction Dr Abhinaba Sarkar CORONARY FELLOW

2. THE STICH TRIAL

3. Surgical Treatment for Ischemic Heart Failure The goal of the trial was to evaluate medical therapy versus surgical therapy for patients with obstructive coronary artery disease (CAD) and congestive heart failure (CHF ) Randomised controlled trial Primary endpoints-All cause mortality Secondary endpoints-longterm survival & cardiovascular hospitalisation Patient population LV ejection fraction ≤0.35 within 3 months of trial entry CAD suitable for CABG Eligible for medical therapy

4. Summary & Conclusions Despite the medical adherence and operative results achieved,the 5-year mortality risk with medical treatment alone is 40% There was no statistical difference between in all-cause mortality in medical therapy alone vs medical therapy+CABG Medical therapy with CABG reduces cardiovascular morbidity and mortality compared to medical therapy alone

5. GUIDELINES

6. Operative challenges Increased Risk of Cardiopulmonary Failure - Patients with LV dysfunction are more prone to postcardiotomy shock and other complications.   Lower Ejection Fraction - Low ejection fraction (EF) is a significant predictor of adverse outcomes after CABG.   Myocardial Protection - Ensuring adequate myocardial protection during surgery is crucial to minimize perioperative myocardial damage.   On-Pump vs. Off-Pump CABG - While off-pump CABG (OPCABG) has been advocated for patients with LVD, its benefit compared to on-pump CABG remains debated.   Surgical Technique and Myocardial Protection - Advances in perioperative management, surgical procedures, and myocardial protection methods have led to improved outcomes, but challenges persist.   Preoperative Optimization - Preoperative optimization with medications or mechanical support is crucial, especially for patients with cardiogenic shock.

7. Risk Stratification - Understanding the predictors of increased operative mortality, such as symptomatic heart failure and reoperation, is essential for guiding clinical decision-making.   ＊ Factors Affecting Outcomes: Preoperative LV Function : Preoperative LVEF is a critical determinant of changes in LV function following surgery.   Patient Characteristics : Age, sex, diabetes, renal disease, and other comorbidities can influence outcomes.   Urgency of Operation : Urgent CABG procedures are associated with higher perioperative mortality

8. THANK YOU