Medium-term results of coronary artery bypass surgery in patients with severe left ventricular dysfunction and preoperatively documented hibernating myocardium.

In patients with multivessel coronary artery disease (CAD), severe left ventricular dysfunction (LVD) and hibernating myocardium (HM) demonstrated on preoperative assessment, coronary artery bypass grafting (CABG) surgery can be performed safely with low operative morbidity and mortality rates. Surgical revascularization of reversibly dysfunctional myocardium improves significantly both patient's clinical status and left ventricular ejection fraction (LVEF). Diagnosis of HM prior to CABG surgery seems to be crucial because it does not leave the patient with multivessel CAD and LVD a candidate only for heart transplantation (HTX). In the presence of HM, more aggressive surgical approach could be recommended to salvage chronically jeopardized but viable myocardium using not only routine CABG procedures in extracorporeal circulation (ECC) but also alternative approach of coronary endarterectomy (EAE) or minimally invasive direct coronary artery bypass grafting (MIDCAB) procedures on beating heart, without any adverse impact on operative mortality.