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Revascularization and Heart Failure

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Heart Failure

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Abstract

The management of patients with ischemic cardiomyopathy involves evaluation of the relative benefits of revascularization versus medical management, or the referral for advanced heart failure therapies. While the decision to proceed with revascularization may be straight-forward in patients with severe angina or important stenosis of the left main coronary artery, many patients have less clear indications for revascularization and require additional evaluation. Viability testing, assessment of hemodynamics or evaluation of mechanical dyssynchrony can provide information that may help define the relative risks of revascularization and medical management. Even in the situation where the operative risk is elevated, it may still be less than the risk of non-operative therapy. When faced with a patient with very high operative risk, one should consider alternative approaches such as cardiac transplantation or the use of long-term ventricular assist devices.

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Abbreviations

AWESOME:

Angina with extremely serious operative mortality evaluation

CABG:

Coronary artery bypass grafting

CASS:

Coronary Artery surgery study

CCS:

Canadian cardiovascular society

CHF:

Congestive heart failure

DES:

Drug-eluting stent

DSE:

Dobutamine stress echocardiography

HEART:

Heart failure revascularization trial

IABP:

Intra-aortic balloon pump

IMA:

Internal mammary artery

LAD:

Left anterior descending

LVAD:

Left ventricular assist device

LVEDVI:

Left ventricular end diastolic volume index

LVESVI:

Left ventricular end systolic volume index

LVEF:

Left ventricular ejection fraction

MRI:

Magnetic resonance imaging

NYHA:

New York Heart Association

OMM:

Optimal medical management

PARR-2:

PET and Recovery following revascularization

PAsP:

Pulmonary artery systolic pressure

PCI:

Percutaneous coronary intervention

PET:

Positron emission tomography

REHEAT:

Revascularization in ischemic heart failure trial

SPECT:

Single-photon emission computed tomography

STICH:

Surgical treatment for ischemic heart failure

SVR:

Surgical ventricular reconstruction

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Authors and Affiliations

  1. Jefferson University Hospital, Department of Surgery, Division of Cardiothoracic Surgery, 1025 Walnut Street Suite 607, College Bldg., Philadelphia, PA, 19107, USA

    John W. C. Entwistle III MD, PhD

  2. Drexel University College of Medicine, Department of Cardiothoracic Surgery, 245 North 15th Street MS 111, Philadelphia, PA, 19102, USA

    Andrew S. Wechsler MD

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  1. John W. C. Entwistle III MD, PhD
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Correspondence to John W. C. Entwistle III MD, PhD .

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Editors and Affiliations

  1. Division of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

    Howard Eisen

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Entwistle, J.W.C., Wechsler, A.S. (2017). Revascularization and Heart Failure. In: Eisen, H. (eds) Heart Failure. Springer, London. https://doi.org/10.1007/978-1-4471-4219-5_18

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  • DOI: https://doi.org/10.1007/978-1-4471-4219-5_18

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