Left ventricular recovery after total arterial coronary artery bypass grafting versus conventional coronary artery bypass grafting in patients with multivessel coronary artery disease and reduced left ventricular ejection fraction

Background We compared total arterial revascularization (TAR) versus conventional revascularization (CR) in terms of left ventricular function recovery in patients with multivessel coronary artery disease (CAD) and reduced left ventricular ejection fraction (LVEF). Methods We conducted a retrospective cohort study of 162 consecutive patients with multivessel CAD and reduced LVEF who underwent isolated coronary artery bypass grafting at our institution between January 2013 and July 2022. We assessed left ventricular function by transthoracic echocardiography at admission, before discharge, and at follow-up of 3, 6, and 12 months, using LVEF, global longitudinal peak strain, end-diastolic volume index, and end-systolic volume index. We also evaluated mitral valve regurgitation and graft patency rate at 1 year. Results The TAR group had a significantly higher increase in LVEF and global longitudinal peak strain, and a significantly lower decrease in end-diastolic volume index and end-systolic volume index than the CR group at 6 and 12 months after surgery. The TAR group also had a significantly lower degree of mitral valve regurgitation than the CR group at all-time points within 12 months after surgery. The TAR group had a significantly higher graft patency rate than the CR group at 12 months. There was no significant difference in hospital mortality or repeat revascularization between the groups. Conclusions TAR was associated with better recovery of left ventricular function than CR in patients with multivessel CAD and reduced LVEF. Further studies are needed to confirm these findings in this high-risk population. What is already known on this topic: Previous studies have shown that coronary artery bypass grafting (CABG) can improve left ventricular function in patients with ischemic cardiomyopathy and heart failure. Total arterial revascularization (TAR) has been shown to have superior long-term outcomes than conventional revascularization (CR). Limited data exist comparing TAR versus CR for left ventricular recovery in those with multivessel disease and reduced ejection fraction. What this study adds: This study compared the recovery of left ventricular function after TAR versus CR in patients with multivessel coronary artery disease and reduced ejection fraction. The results showed that TAR was associated with better recovery of left ventricular function than CR. TAR was also associated with lower degree of mitral regurgitation and higher graft patency rate than CR at 12 months after surgery. How this study might affect research, practice or policy: This study suggests that TAR may have a beneficial effect on the remodeling and contractility of the left ventricle in this patient population. TAR may be the optimal revascularization strategy for patients with multivessel CAD and reduced LVEF, as it may improve left ventricular function and overall outcomes. More studies are needed to address these issues and to provide more robust evidence for the use of TAR in this high-risk population.