Abstract
Heart failure with reduced ejection fraction (HFrEF) is frequently observed in patients undergoing coronary artery bypass grafting (CABG), and it significantly increases the risk of postoperative death while exerting a crucial influence on the recovery process following the surgical intervention. HFrEF is one of the prevalent risk factors for early readmission in patients who underwent CABG. Angiotensin receptor-neprilysin inhibitor (ARNI) has been recognized as a critical medical therapy in the management of HFrEF; however, its efficacy and safety have yet to be corroborated in the context of CABG. Therefore, this opinion document developed by a group of cardiothoracic and vascular surgeons in India focuses on the utilization of ARNI for patients with HFrEF, including those undergoing or having undergone CABG. These opinions based on clinical experience include perioperative use of ARNI; postoperative initiation of ARNI; strategies for addressing challenges such as hyperkalemia, hypotension, and renal dysfunction; and initiation of other foundational medical therapies in HFrEF management in the context of CABG.