Coronary artery surgery for ischemic heart failure: Risks, benefits, and the importance of assessment of myocardial viability

Pitt, Michael; Lewis, Michael; Bonser, Robert S.

doi:10.1053/pcad.2001.20672

Cited by 17 publications

(12 citation statements)

References 68 publications

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“…Therefore, it is generally (though not universally) believed that selection of patients who have coronary artery disease and left ventricular dysfunction for surgical revascularization be based on the presence of viable myocardium [8][9][10].…”

Section: Coronary Revascularization In the Patient With Severe Left Vmentioning

confidence: 99%

Surgical aspects of congestive heart failure

2006

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Despite tremendous advances in the medical management of congestive heart failure the gold standard for the treatment of end stage congestive heart failure remains cardiac transplantation. The acknowledged critical limitation of sufficient suitable organ donors has resulted in the refinement and development of novel surgical alternatives for the treatment of congestive heart failure. These approaches include the extension of current conventional cardiac operations such as mitral valve repair to the failing ventricle, surgically reconstructing the size and shape of the failing left ventricle in order to optimize geometry and render it a more efficient pump, and partial or complete replacement of the ventricle with a mechanical device. The continued evolution of such therapies is likely to one day have a significant epidemiologic impact on patients suffering from end stage heart failure.

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Section: Coronary Revascularization In the Patient With Severe Left Vmentioning

confidence: 99%

Surgical aspects of congestive heart failure

2006

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“…ISCM is defined as LV systolic dysfunction secondary to CAD. Specifically, an LV ejection fraction (LVEF) less than some arbitrary number, typically 0.35, with segmental wall motion abnormalities and angiographic documentation of CAD, are all required to make the diagnosis 1–5 . CAD is defined angiographically as a narrowing of >70% of the luminal diameter of one or more major epicardial coronary artery.…”

Section: Definition Of Termsmentioning

confidence: 99%

“…It was once believed that CAD led to the development of ischemic cardiomyopathy (ISCM) by means of irreversible myocardial necrosis or infarction, leading to the concept that revascularization of such patients was likely too late. The recognition that contraction abnormalities could accrue from gradual stunning, or longer‐term “hibernation,” raised the possibility that revascularization of viable but hypocontractile elements could improve myocardial performance 3–9 . This review will address:…”

mentioning

confidence: 99%

What Is the Evidence for Percutaneous Coronary Intervention or Coronary Artery Bypass Graft in Ischemic Cardiomyopathy?

Morrison

2005

Amer Heart Hosp J

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Coronary artery disease has supplanted hypertension as the leading cause of congestive heart failure in the United States. The recognition that contraction abnormalities could accrue from gradual stunning, or longer-term 'hibernation,' raised the possibility that revascularization of viable but hypocontractile elements could improve myocardial performance. This review focuses on the data from randomized trials and registries regarding the potential benefits and risks of either coronary artery bypass grafting (CABG) or percutaneous coronary intervention for patients with severe left ventricular dysfunction secondary to coronary artery disease. For patients with medically refractory angina and ischemic cardiomyopathy, revascularization with CABG or percutaneous coronary intervention is recommended. The ongoing National Institutes of Health-sponsored Surgical Treatment for Ischemic Heart Failure (STICH) trial, a multicenter, prospective, randomized trial comparing contemporary medical therapy with CABG for patients with ischemic cardiomyopathy, should provide important information regarding patients who do not have angina. The conclusion of this review is that a trial of medical therapy vs. percutaneous coronary intervention could be of additional value, especially for patients at particularly high risk, when undergoing CABG.

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“…36 Optimal revascularization in patients with impaired LV systolic function has not received proper attention and is in great need of review. 37,38 In the Bypass Angioplasty Revascularization Investigation (BARI) trial, of the patients with ischemic left ventricular dysfunction that survive 5 years after revascularization, assignment to either bypass surgery or PTCA did not appear to play a difference in ventricular function at 5-year follow-up, 39 though most patients had normal ventricular function at the outset. In patients with more severe multivessel disease, PCI provides equivalent outcomes compared with CABG except for treated diabetics and possibly patients with severe LV dysfunction.…”

Section: Indication For Pci: Left Ventricular Dysfunctionmentioning

confidence: 99%

The Current and Future Role of Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

Lipinski

Fearon

Froelicher

et al. 2004

J Interven Cardiology

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With increasing research on vulnerable plaques and uncertainty regarding which lesions require revascularization, the goal of this review is to clarify the indications for percutaneous coronary intervention and discuss which lesions do not warrant treatment by intervention. This paper also briefly reviews the potential advantages and limitations of technology that may enable detection of atherosclerotic plaques that are prone to rupture and discusses the future utility of these technologies in prevention of acute coronary syndromes. Providing an evidence-based understanding of lesion morphology and clinical variables that influence outcome enables the interventional cardiologist to determine which atherosclerotic plaques require PCI.

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Coronary artery surgery for ischemic heart failure: Risks, benefits, and the importance of assessment of myocardial viability

Cited by 17 publications

References 68 publications

Surgical aspects of congestive heart failure

Surgical aspects of congestive heart failure

What Is the Evidence for Percutaneous Coronary Intervention or Coronary Artery Bypass Graft in Ischemic Cardiomyopathy?

The Current and Future Role of Percutaneous Coronary Intervention in Patients with Coronary Artery Disease

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