{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:00:20Z","timestamp":1792123220927,"version":"4.4.0"},"reference-count":36,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T00:00:00Z","timestamp":1757030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Open Access Fond\u2014University of Tuebingen"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background: Total arterial revascularization (TAR) may improve outcomes in patients with ischemic cardiomyopathy and heart failure with reduced ejection fraction (HFrEF). Methods: We retrospectively screened 574 adults with HFrEF (LVEF &lt; 40%) undergoing isolated CABG across four German centers (2017\u20132023). After 1:1 propensity score matching, 240 patients were analyzed (120 TAR vs. 120 NTAR). The primary endpoint was in-hospital MACCE (death, MI, stroke). Key secondary endpoints included ICU\/hospital length-of-stay, ventilation time, delirium, transfusion requirements, and acute kidney injury. Results: MACCE occurred in 4.1% (TAR) vs. 14.2% (NTAR) (p = 0.007). TAR was associated with shorter ICU stay (median 44.5 h vs. 90 h, p &lt; 0.001), shorter hospital stay (10 d vs. 12 d, p = 0.002), reduced ventilation time (8 h vs. 12 h, p &lt; 0.001), lower delirium (5.0% vs. 14.2%, p = 0.016), and fewer RBC transfusions intra-operatively (0.13 \u00b1 0.45 vs. 0.31 \u00b1 0.58 units, p = 0.028) and during the entire stay (0.70 \u00b1 1.33 vs. 1.77 \u00b1 2.91 units, p &lt; 0.001). Conclusions: In this multicenter propensity-matched cohort, TAR was associated with lower in-hospital MACCE and more favorable perioperative outcomes compared with NTAR. Prospective studies are warranted to confirm causality and long-term benefits.<\/jats:p>","DOI":"10.3390\/medsci13030179","type":"journal-article","created":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T09:51:21Z","timestamp":1757065881000},"page":"179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Total-Arterial Revascularization Is Superior in Heart Failure Patients with Reduced Ejection Fraction\u2014A Propensity Score Matched Retrospective Multicenter Analysis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2178-8397","authenticated-orcid":false,"given":"Christian J\u00f6rg","family":"Rustenbach","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Schano","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7155-6039","authenticated-orcid":false,"given":"Christoph","family":"Salewski","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"H\u00e4berle","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8274-0691","authenticated-orcid":false,"given":"Kristian-Christos","family":"Ngamsri","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5810-8626","authenticated-orcid":false,"given":"Ilija","family":"Djordjevic","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-0953","authenticated-orcid":false,"given":"Stefanie","family":"Wendt","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5697-2659","authenticated-orcid":false,"given":"Tulio","family":"Caldonazo","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University, University Hospital of Jena, 07743 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Saqer","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University, University Hospital of Jena, 07743 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9903-3237","authenticated-orcid":false,"given":"Shekhar","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ludwig-Maximilians-University, 80539 Munich, Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schnackenburg","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ludwig-Maximilians-University, 80539 Munich, Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5182-8295","authenticated-orcid":false,"given":"Lina Maria","family":"Serna-Higuita","sequence":"additional","affiliation":[{"name":"Institute for Clinical Epidemiology and Applied Biostatistics, Eberhard-Karls-University of Tuebingen, 72074 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Doenst","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University, University Hospital of Jena, 07743 Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hagl","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Ludwig-Maximilians-University, 80539 Munich, Germany"},{"name":"German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80539 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thorsten","family":"Wahlers","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50923 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schlensak","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Reichert","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, German Cardiac Competence Center, Eberhard-Karls-University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.jtcvs.2021.04.052","article-title":"2021: The American Association for Thoracic Surgery Expert Consensus Document: Coronary artery bypass grafting in patients with ischemic cardiomyopathy and heart failure","volume":"162","author":"Bakaeen","year":"2021","journal-title":"J. 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