Di Tommaso, Ettorino (2025) Investigating predictors of poor outcomes in patients with heart failure undergoing coronary artery bypass grafting. [Tesi di dottorato]

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Abstract

This thesis investigates factors influencing outcomes in patients with heart failure undergoing coronary artery bypass grafting (CABG) surgery. The study analyzes the impact of left ventricular ejection fraction (LVEF), chronic obstructive pulmonary disease (COPD), sex, and surgical techniques on patient outcomes. Key findings of this study include: 1. Low LVEF is associated with increased perioperative mortality, longer hospital stays, and reduced long-term survival after CABG. Patients with poor LVEF also tend to have a higher incidence of previous myocardial infarctions, COPD, and other comorbidities. 2. COPD is identified as an independent risk factor for higher rates of postoperative complications and mortality following CABG. Patients with COPD undergoing CABG are more likely to have longer hospital stays and a higher risk of in-hospital mortality. They also tend to receive fewer left internal mammary artery (LIMA) grafts and are less likely to undergo off-pump CABG. 3. Female sex is an independent risk factor for increased in-hospital and long-term mortality after CABG. Female patients are often older, have a higher burden of cardiovascular disease, and a higher prevalence of diabetes compared to males. They also tend to receive fewer grafts and are less likely to receive a LIMA graft. 4. Off-pump CABG (OPCAB)** may be advantageous for high-risk patients, particularly in reducing the risk of cardiopulmonary bypass (CPB)-related complications such as stroke and renal failure. However, on-pump CABG remains the standard approach for complex multi-vessel disease to facilitate more accurate grafting. The study emphasizes the importance of **personalized risk assessment** and management in cardiac surgery. It recommends enhanced preoperative assessments, individualized surgical approaches (including the consideration of OPCAB for select high-risk patients), and gender-specific considerations to improve outcomes. The findings suggest that optimizing medical management before surgery, and providing tailored postoperative care are essential to improve outcomes in this high-risk population. Future research should focus on advanced myocardial protection techniques, identifying reliable biomarkers and developing predictive tools, and further investigating optimal risk reduction strategies for women and COPD patients.

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