Review: Do We Still Need a Viability Study before Considering Revascularization in Patient with Stable Coronary Artery Disease and Significant Left Ventricular Systolic Dysfunction?

Abstract

Patients with ischemic cardiomyopathy constitute a heterogeneous group of patients with an extremely complex condition in which many factors play an important prognostic role. So it is difficult and probably unrealistic to expect that a single feature like presence of viable myocardium would provide an unequivocal answer to a critical question of revasculrization or not for all patients. Opposite to the hopes of investigators and physicians involved in the care of these patients, the findings of prospective studies with the use of different viability testing methods did not help in the decision-making process regarding CABG in ischemic cardiomyopathy. Instead, they left us with the same dilemma. The implication of most of these trials is that in patients with CAD and significant LV dysfunction, assessment of myocardial viability does not identify patients who will have the greatest survival benefit from adding CABG to aggressive medical therapy. In the clinical practice, these observations remind physicians to consider the multiplicity of factors involved in the decision-making process for patients with such a complex disease.

Estimating postoperative left ventricular volume: Identification of responders to surgical ventricular reconstruction

“…Some previous studies focused on myocardial viability, which could be indicated by the extent of postoperative improvement of EF, as an important predictor of survival after CABG for ischemic heart disease, although it remains controversial. [17][18][19][20][21] Our results suggested that it could be required for better survival to keep postoperative EF as high as possible, regardless of the postoperative change of this parameter. Therefore, in consideration of whether SVR should be added or not, the perspective that a higher postoperative EF could be estimated with SVR than without it could encourage surgeons to perform the procedure.…”