[Severe ventricular dysfunction. When should is surgery not indicated?]

The decision to operate in the presence of severe ventricular dysfunction is one of the most difficult medical judgements because ventricular dysfunction is, as we know, the leading risk factor for morbidity and mortality in cardiac surgery. However, despite the greater surgical risk in some pathologies, the patients with severe cardiac dysfunction are those who will most likely benefit from surgery when we compare medical and surgical survival curves. Although ejection fraction is the parameter usually used to quantify ventricular systolic function and to stratify patients according to risk, we should not ignore the limitations of this parameter in the evaluation of myocardial function. Therefore, besides ejection fraction, other criteria should be considered in the process of patient selection for surgery. Taking these facts into consideration, the author seeks to establish criteria for different cardiac pathologies for the surgical treatment of patients with severe left ventricular dysfunction.