AUTHOR=Nersesian Gaik , Abd El Al Alaa , Schoenrath Felix , Zittermann Armin , Hell Laurenz , Falk Volkmar , de By Theo M. M. H. , Fox Henrik , Schramm Rene , Morshuis Michiel , Gummert Jan , Potapov Evgenij , Rojas Sebastian V. 

TITLE=Propensity score-based comparison of high-risk coronary artery bypass grafting vs. left ventricular assist device implantation in patients with coronary artery disease and advanced heart failure

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2024.1430560

DOI=10.3389/fcvm.2024.1430560

ISSN=2297-055X

ABSTRACT=<sec><title>Objectives</title><p>Revascularization in patients with severely reduced left ventricular function and coronary artery disease (CAD) is associated with a high perioperative risk. In this setting, implantation of a durable left ventricular assist device (LVAD) might be an alternative.</p></sec><sec><title>Methods</title><p>We retrospectively compared the outcomes of adult patients with CAD and a left ventricular ejection fraction (LVEF) ≤ 25% who underwent coronary artery bypass grafting (CABG) vs. LVAD implantation. Propensity score (PS) matching was performed for statistical analysis, resulting in 168 pairs.</p></sec><sec><title>Results</title><p>In the PS-matched cohorts, the mean age was 62 years; one third had a history of myocardial infarction, 11% were resuscitated, half of the patients were on inotropic support, and 20% received preoperative mechanical circulatory support. LVAD patients required significantly longer ventilation (58 h [21, 256] vs. 16 h [9, 73], <italic>p</italic> &lt; 0.001) and had a longer ICU stay (11d [7, 24] vs. 4d [2, 10], <italic>p</italic> ≤ 0.001) compared to CABG patients The incidence of postoperative renal replacement therapy (2 [1.2%] vs.15 [8.9%], <italic>p</italic> = 0.002) and temporary mechanical circulatory support was lower in the LVAD group (1 [0.6%] vs. 51 [30.4%], <italic>p</italic> ≤ 0.001). The in-hospital stroke rate was similar (LVAD 7 [5.4%] vs. CABG 8 [6.2%], <italic>p</italic> = 0.9). In-hospital survival, 1-year survival, and 3-year survival were 90.5% vs. 85.5% (<italic>p</italic> = 0.18), 77.4% vs. 68.9% (<italic>p</italic> = 0.10) and 69.6% vs. 45.9% (<italic>p</italic> &lt; 0.001), for CABG and LVAD patients respectively.</p></sec><sec><title>Conclusion</title><p>Patients with CAD and advanced HF demonstrate better mid-term survival if they undergo CABG rather than LVAD implantation.</p></sec>