Survival and outcomes of coronary artery bypass grafting in patients with extremely low ejection fraction (≤20%): A systematic review and meta-analysis.

OBJECTIVES: To assess perioperative outcomes and long-term survival of coronary artery bypass in patients with ejection fraction (EF) 20% or less. METHODS: We performed a systematic search of MEDLINE, EMBASE, and CENTRAL via OVID for both randomized controlled trials and cohort studies involving patients with EF ≤20% undergoing coronary artery bypass grafting, including results from 1995 to December 2023. Random-effects prevalence meta-analysis was performed using the meta library in R. Outcome prevalence was logit-transformed and pooled using a generalized linear mixed-effects model. The presence of heterogeneity was assessed using the Cochran Q test with a significance of P < .10 following Cochrane Handbook recommendations and further quantified using I 2 statistic. RESULTS: A total of 29 studies involving 5910 patients were included in this analysis. The pooled prevalence of perioperative mortality was 9%. Postoperative myocardial infarction and stroke prevalence were 2% and 3%, respectively. Low cardiac output syndrome definition varied across studies, and its pooled prevalence was 16%, with postoperative mechanical circulatory support requirement at 9%, the pooled 5-year survival rate was 74%. CONCLUSIONS: Despite elevated short-term risk, patients with severely low LVEF (≤20%) may derive long-term survival benefit from coronary artery bypass grafting and therefore it should remain a consideration in advanced heart failure therapies.