Abstract 4141581: Surgical revascularization of ischemic heart failure: a comparison between patients with preserved (HFpEF) and reduced ejection fraction (HFrEF).

Introduction: Despite surgical myocardial revascularization(CABG) in patients with ischemic HF and reduced EF(HFrEF) is strongly supported, there is only limited evidence to guide revascularization in patients with HF and preserved EF(HFpEF). Research Questions: Should CHF be considered an independent risk-factor in patients undergoing CABG, irrespectively of preoperative LVEF? Aims: To determine the prognostic role of preserved versus reduced EF on the outcomes of patients with ischemic HF undergoing CABG. Methods: Between 2005-2019, 4079 consecutive patients with multivessel CAD underwent isolated, on-pump CABG at a single institution. Preoperative CHF was ascertained according to clinical symptoms, laboratory values and medical therapy. Preserved LV function was defined as EF≥50%. Accordingly, the study population was divided into 4 groups: Group I [NoHFpEF,2663 pts(65%)], Group II [HFpEF,214 pts(5%)], Group III [NoHFrEF,970 pts(24%)], and Group IV [HFrEF,232 pts(6%)]. A deterministic record linkage with the National Health Institute Database allowed unique identification of long-term mortality and major adverse cardiovascular events[acute MI, repeated PCI and HF admission(MACE)]. Results: Patients with HFpEF presented with a similar preoperative clinical profile compared to NoHF patients, while the incidence of comorbidities significantly increased through reduced EF groups. Completeness of revascularization was consistent across the study groups. Perioperative morbidity was similar between HFpEF and NoHF patients, but progressively increased in reduced EF groups. Moreover, 30-day mortality was comparable between HFpEF and Group I(1.4%vs1.2%, P=NS), but significantly increased in Group III(3.1%) and IV(5.6%, p<0.01 ). Finally, HFpEF showed a 10-years survival comparable to Group III(63%vs61%, p=NS) but significantly reduced to Group I(75%, p<0.01 ). On the contrary, 10-year freedom from MACE was comparable between HFpEF and Group I(60%vs 67%, p=0.34), and significantly higher than Group III and IV(47% and 38% respectively, p<0.01 – Figure1 ). Conclusions: HFpEF patients undergoing CABG showed comparable perioperative results to non-HF patients and significantly better long-term outcomes compared to HFrEF patients.