Off-Pump Coronary Artery Bypass with Incomplete Revascularization in a Patient with Severely Reduced LVEF: A Case Report and Literature Review

Background: Patients with ischemic cardiomyopathy and severely reduced left ventricular ejection fraction (LVEF ≤30%) face high operative risk during CABG, particularly when cardiopulmonary bypass (CPB) is used. Off-pump CABG may reduce complications in these patients, though incomplete revascularization is sometimes necessary due to anatomical or clinical constraints.Case Summary: A 67-year-old male with ischemic cardiomyopathy (LVEF 20%), multivessel coronary artery disease, renal dysfunction, and significant dilatation of the left heart chambers underwent incomplete revascularization via OPCAB. A left internal mammary artery graft was placed to the anterior intraventricular coronary artery, the most viable and surgically accessible vessel. PCI was not pursued due to diffuse calcification and poor distal targets. The patient remained stable postoperatively and showed improvement in LVEF to 30% and NYHA Class II symptoms at two-year follow-up.Outcome: The patient remained clinically stable without readmissions or recurrent ischemic events and continues guideline-directed therapy with satisfactory quality of life.Conclusion: In select high-risk patients with poor coronary anatomy and severely reduced LVEF, incomplete revascularization via OPCAB guided by myocardial viability may provide durable functional and echocardiographic improvement. Further studies are needed to guide patient selection and long-term outcomes.