Left Ventricular Venting during On-Pump Beating-Heart Coronary Artery Bypass Grafting for Advanced Ischemic Cardiomyopathy: A Surgical Strategy to Achieve Complete Revascularization.

We describe a surgical strategy combining on-pump beating-heart coronary artery bypass grafting (OPBH CABG) with left ventricular (LV) venting for patients with advanced ischemic cardiomyopathy (ICM) with severe LV dysfunction and marked LV dilation. This strategy provides LV decompression, reduces myocardial workload, and improves surgical exposure during coronary anastomosis, facilitating complete revascularization. Between January 2013 and September 2024, 7 patients underwent OPBH CABG with LV venting. Six patients had chronic ICM with dilated ventricles and severe systolic dysfunction, and 1 presented with acute coronary syndrome and impaired LV function. The median age was 65 years (interquartile range [IQR], 61-80). The median left ventricular ejection fraction was 21.7% (IQR, 19.2-27.9), and the median left ventricular end-diastolic diameter was 61.6 mm (IQR, 58.7-69.3). Complete revascularization was achieved in all patients without additional mechanical circulatory support. There were no in-hospital deaths or postoperative complications. This strategy may enable complete revascularization in selected high-risk patients while contributing to myocardial unloading.