Impact of Reduced Pre-Operative Ejection Fraction on Early Clinical Outcomes After Coronary Artery Bypass Grafting
Bedirhan Buğra Bayıcı
, Fatih Kızılyel, Safa Özçelik, Mehmet Rum, Murat Bülent Rabuş
Department of Cardiovascular Surgery, Koşuyolu High Specialty Training and Research Hospital, İstanbul, Türkiye
Keywords: Cardiac surgery; coronary artery bypass grafting; ejection fraction; hospital length of stay; left ventricular dysfunction; post-operative morbidity.
Abstract
Objective: While a reduced left ventricular ejection fraction (EF) is a well-known risk factor for adverse outcomes following coronary artery bypass grafting (CABG), its specific impact on the immediate post-operative recovery phase, such as the likelihood of an extended hospital stay or the need for mechanical circulatory support, is still not fully understood.
Methods: We reviewed the records of 482 patients who underwent isolated CABG at our center in this retrospective cohort study. Patients were stratified into two categories based on their pre-operative EF: those with an EF <40% and those with an EF ≥40%. Our primary focus was observing prolonged hospital stays, defined as lasting more than 6 days. We also examined secondary recovery metrics, including time spent in the intensive care unit (ICU), duration of mechanical ventilation, and the utilization of an intra-aortic balloon pump (IABP). To pinpoint the true independent predictors of a prolonged stay, we applied multivariate logistic regression analysis.
Results: Patients entering surgery with an EF <40% (n=25) experienced noticeably longer hospitalizations compared to the higher EF group (median 7 [6–10] days vs. 6 [5–7] days, p=0.001). They also required IABP support at a significantly higher rate (28.0% vs. 5.9%, p<0.001). While these patients tended to spend more time in the ICU, this trend narrowly missed statistical significance (p=0.057). After adjusting for other variables, having an EF <40% remained a strong, independent predictor of a prolonged hospital stay (odds ratio [OR]: 4.42, 95% confidence interval [CI]: 1.67–11.74, p=0.003). In addition, the duration of cardiopulmonary bypass emerged as another independent risk factor for extended hospitalization (OR: 1.007, 95% CI: 1.002–1.012, p=0.008).
Conclusion: A reduced pre-operative EF is an independent driver of delayed hospital discharge and a heightened need for mechanical heart support following CABG. Tracking EF provides clinicians with a highly practical tool for anticipating early post-operative challenges and tailoring patient care accordingly.
Cite This Article: Bayıcı BB, Kızılyel F, Özçelik S, Rum M, Rabuş MB. Impact of Reduced Pre-Operative Ejection Fraction on Early Clinical Outcomes After Coronary Artery Bypass Grafting. Koşuyolu Heart J 2026;29(3):157–161