Preoperative, Multidisciplinary Clinical Optimization of Patients with Severely Depressed Left Ventricular Ejection Fraction Who Are Undergoing Coronary Artery Bypass Grafting

Islam Mohammad Shehata; Tiffany D Odell; Amir Elhassan; Maxim Spektor; Ivan Urits; Omar Viswanath; George M Jeha; Elyse M Cornett; Alan D Kaye

doi:10.1007/s40119-020-00207-1

Preoperative, Multidisciplinary Clinical Optimization of Patients with Severely Depressed Left Ventricular Ejection Fraction Who Are Undergoing Coronary Artery Bypass Grafting

Cardiol Ther. 2021 Jun;10(1):57-66. doi: 10.1007/s40119-020-00207-1. Epub 2020 Dec 23.

Authors

Islam Mohammad Shehata¹, Tiffany D Odell², Amir Elhassan³, Maxim Spektor⁴, Ivan Urits^{5

6}, Omar Viswanath^{6

7

8

9}, George M Jeha¹⁰, Elyse M Cornett⁶, Alan D Kaye¹¹

Affiliations

¹ Department of Anesthesiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
² Department of Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA.
³ Department of Anesthesiology, Desert Regional Medical Center, Palm Springs, CA, USA.
⁴ Department of Surgery, Desert Regional Medical Center, Palm Springs, CA, USA.
⁵ Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁶ Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA.
⁷ Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA.
⁸ Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.
⁹ Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ, USA.
¹⁰ Louisiana State University Health Sciences Center, New Orleans, LA, USA.
¹¹ Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA. akaye@lsuhsc.edu.

Abstract

Coronary artery bypass grafting (CABG) remains a routine operation despite major advancements in angioplastic procedures. Around 200,000 CABG procedures are performed annually in the U.S. Patients who are not candidates for angioplasty intervention often have advanced coronary disease and comorbidities that raise the risk of heart failure with decreased ejection fraction to around 25%. Over the years, significant developments in various preoperative interventions have occurred; in this paper, we suggest a multidisciplinary preoperative algorithm that can be included in a regularly scheduled multidisciplinary care plan.

Keywords: Cardiomyopathy; Coronary artery bypass; Low ejection fraction; Preoperative optimization.

Publication types

Review