Effect on Left Ventricular Ejection Fraction After off Pump Coronary Artery Bypass Grafting of Triple Vessels Ischemic Heart Disease with Viable Myocardial Tissues

<i>Background:</i> Patients with triple-vessel ischemic heart disease and reduced left ventricular ejection fraction (LVEF) present a high-risk surgical population. Off-pump coronary artery bypass grafting (OPCAB) has been proposed as a safe revascularization strategy with potential for functional recovery. This study aimed to evaluate changes in LVEF and perioperative outcomes following OPCAB in patients stratified by baseline LVEF.<i> Methods:</i> This descriptive cross-sectional study was conducted in the Department of Cardiac Surgery, Bangladesh Medical University, Dhaka, from September 2024 to August 2025. A total of 120 patients with angiographically confirmed triple-vessel ischemic heart disease and viable myocardium assessed by Dobutamine stress echocardiography underwent OPCAB. Patients were divided into four groups according to baseline LVEF: Group A (20–30%), Group B (31–40%), Group C (41–50%) and Group D (>51%). LVEF was measured by transthoracic echocardiography preoperatively, on the 7th postoperative day, at 1 month and at 3 months.<i> Results:</i> The mean age of the study population was 55.8 ± 7.0 years, with males comprising 68%. Progressive improvement in LVEF was observed in all groups. Group A showed the largest relative gain (25 ± 3% to 36 ± 5% at 3 months), with 83% achieving ≥5% improvement and 50% achieving ≥10%. Overall, 64% of patients improved by ≥5% and 28% by ≥10%. Perioperative mortality was low (0.8%), while postoperative myocardial infarction (3.3%), arrhythmias (11.7%), prolonged ICU stay (18.3%) and wound infection (3.3%) were observed, particularly among patients with lower baseline EF.<i> Conclusion:</i> OPCAB in patients with triple-vessel ischemic heart disease and viable myocardium is associated with significant improvement in LVEF, particularly in those with lower baseline EF and carries a low incidence of perioperative complications.