THE PROGNOSTIC IMPACT OF HEART FAILURE WITH PRESERVED EJECTION FRACTION IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS GRAFTING

Background and Aim: Despite hard evidence in favour of surgical myocardial revascularization (CABG) in patients with ischemic heart failure (HF) and reduced ejection fraction (HFrEF), data in patients with HF and preserved EF (HFpEF) are scarce. We aim to determine the prognostic role of preserved versus reduced EF on the outcomes of patients with ischemic HF undergoing CABG. Methods: Between 2005 and 2018, 4079 consecutive patients with multivessel CAD underwent isolated, on-pump CABG at a single institution. Preoperative HF was ascertained according to clinical data. Preserved LV function was defined as EF ≥ 50%. Accordingly, our population was divided into 4 groups: Group I (noHFpEF, 65%), Group II (HFpEF, 5%), Group III (noHFrEF, 24%), and Group IV (HFrEF, 6%). Results: HFpEF and noHFpEF presented with a similar preoperative clinical profile, while the incidence of comorbidities increased in rEF patients. Perioperative morbidity was similar between HFpEF and noHF patients, but postoperative complications increased with rEF. 30-day mortality was comparable between group I and II, but significantly increased in Group III and IV (from 1.2% up to 5%). Finally, HFpEF showed a 10-years survival comparable to Group III, but significantly reduced when compared to Group I. 10-year freedom from MACE was comparable between Group I and II, and significantly higher than Group III and IV. Conclusions: In our experience, HFpEF patients undergoing CABG showed excellent perioperative results while proving a similar risk profile, moreover their long- term outcomes are, as expected, worse than noHFpEF patients and yet significantly better compared to HFrEF patients.