Conventional cardiac surgery in patients with end-stage coronary artery disease: yesterday and today

Abstract

Surgical therapy of combined coronary artery disease (CAD) and heart failure, also referred to as end-stage CAD, has evolved throughout the years and patients are currently being offered traditional coronary artery bypass grafting (CABG), with or without surgical ventricle restoration (SVR), interventions for ischemic mitral valve regurgitation, heart transplantation or implantation of mechanical cardiovascular support systems. Among surgical methods, operative myocardial revascularization (with or without ventricle restoration) is still playing an important role, aiming at restoration of proper myocardial perfusion, especially if heart muscle viability is present. Facing the donor shortage, CABG may constitute a valuable alternative to transplantation in selected patients. In individuals considered not suitable for surgical revascularization, implantation of mechanical circulatory support (MCS) not only appears as a salvage procedure, but also allows for reevaluation of future therapy directions. This article aims at providing an overview of evolving and current surgical practices in patients with end-stage CAD.

Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization

“…Patients with coronary artery disease and concomitant heart failure (left ventricular ejection fraction [LVEF] < 35%) requiring myocardial revascularization are at risk of poor long-term prognosis and higher mortality [ 1 ]. In this population, the appropriate selection of perioperative techniques and strategies is crucial for the prevention of acute kidney injury (AKI) that frequently occurs after cardiopulmonary bypass (CPB).…”

Minimal Invasive Extra-corporeal Circulation on End Stage Coronary Artery Disease Patients Undergoing Myocardial Revascularization

“…Patients with coronary artery disease (CAD) undergoing myocardial revascularization, with concomitant heart failure de ned by left ventricular ejection fraction (LVEF) lower than 35%, constitute a population at risk of poor long-term prognosis and limited survival [21]. Acute kidney injury (AKI) in this population frequently occur after cardiopulmonary bypass and the perioperative techniques and strategies selection could be crucial for the prevention.…”