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Cell-based Therapy for Heart Failure in Rat: Double Thoracotomy for Myocardial Infarction and Epicardial Implantation of Cells and Biomatrix
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Revascularization for heart failure

Harry R Phillips1, Christopher M O'Connor, Joseph Rogers

  • 1Duke University Medical Center, Durham, NC 27710, USA. phill014@mc.duke.edu

American Heart Journal
|March 31, 2007
PubMed

Insights

Revascularization may improve outcomes for heart failure patients with ischemic cardiomyopathy. Choosing between coronary artery bypass grafting and percutaneous coronary intervention depends on individual patient factors and ejection fraction.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Coronary artery disease is a leading cause of heart failure.
  • The role of revascularization in ischemic cardiomyopathy lacks consensus.
  • Myocardial viability is key to revascularization benefits.

Purpose of the Study:

  • To review the role of revascularization in ischemic cardiomyopathy.
  • To discuss the selection of patients for revascularization.
  • To compare coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).

Main Methods:

  • Review of observational studies and registry data.
  • Discussion of pathophysiologic principles of myocardial recovery.
  • Consideration of clinical decision-making in heart failure management.

Main Results:

  • Observational data suggest improved outcomes with revascularization (CABG or PCI) versus medical therapy.
  • Viability testing may identify patients who benefit most.
  • Registry data favor CABG over PCI in reduced ejection fraction patients.
  • PCI is a reasonable option for focal disease, comorbidities, or prior surgery if complete revascularization is achievable.

Conclusions:

  • Revascularization is a potential strategy for heart failure with ischemic cardiomyopathy.
  • Patient selection using viability testing is important.
  • CABG and PCI are complementary approaches, with choices guided by patient-specific factors.

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