Management of Heart Failure

Abstract

Coronary artery bypass grafting improves 3-year survival by approximately 30% to 50% and physical functioning by approximately one New York Heart Association class in patients with moderate to severe left ventricular dysfunction and limiting angina. However, the operative mortality ranges from 5% to 30% depending on patients' ejection fractions and comorbidity. It is not clear whether patients whose predominant symptom is heart failure rather than angina benefit from bypass surgery or how much ischemia is required to justify surgical intervention. Clinical outcomes after angioplasty have not been adequately studied to determine the relative risks and benefits compared with bypass grafting.

Efficacy of aneurysmectomy in patients with severe left ventricular dysfunction: favorable short- and long-term results in ischemic cardiomyopathy

“…The rationale for not employing the left thoracic artery in the past in patients with ICM was due to apprehension about complications related to advanced age, urgency of revascularization, and reserved anxiety about long‐term prognosis 16. However, the findings of this study and other recent studies16,17,19-23 suggest that there is little cause for concern. Thus, patients with ICM should be managed with a left internal thoracic artery graft when revascularization is selected therapy 15.…”

KSHF Guidelines for the Management of Acute Heart Failure: Part III. Specific Management of Acute Heart Failure According to the Etiology and Co-morbidity

“…Despite the recent advances in medical treatment, patients with severe coronary artery disease and decreased left ventricular contractility typically have poor prognosis with drug treatment alone 13). Elective reperfusion therapy can increase the survival rate of such patients,14)15)16)17)18)19)20)21)22) whereas coronary artery bypass grafting can be considered in patients with ischemic heart disease and severe left ventricular dysfunction, where it is expected to increase survival regardless of myocardial variability 15)20)23)24)25)26)27)…”

Treatment options in end-stage heart failure: where to go from here?

“…Revascularisation may potentially improve the outcome of patients with ischaemic cardiomyopathy. Despite the significant periprocedural risk of morbidity and mortality, several studies demonstrated a higher survival rate and improved New York Heart Association (NYHA) functional class in patients with HF after coronary artery bypass grafting (CABG) compared with patients on optimal medical therapy only [7, 8]. …”