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Revascularization surgery as a treatment concept for heart failure

J Ennker1, S Bauer, I C Ennker

  • 1Mediclin Heart Institute Lahr/Baden, Lahr, Germany ; University Witten-Herdecke, Faculty of Health, School of Medicine.

HSR Proceedings in Intensive Care & Cardiovascular Anesthesia
|July 27, 2013
PubMed

Insights

Revascularization surgery improves outcomes for patients with ischemic cardiomyopathy and viable myocardium. Late gadolinium enhancement cardiovascular magnetic resonance accurately predicts functional recovery, guiding treatment decisions for heart failure.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Ischemic cardiomyopathy presents a poor prognosis for heart failure patients without effective treatment.
  • Coronary artery revascularization is an established treatment for patients with viable ischemic myocardium.
  • Predicting regional functional recovery is crucial for assessing myocardial viability and guiding revascularization indications.

Purpose of the Study:

  • To highlight the role of late gadolinium enhancement cardiovascular magnetic resonance in assessing myocardial viability.
  • To discuss the predictors of survival and the impact of various revascularization strategies.
  • To explore advancements in surgical techniques and medical therapies for ischemic cardiomyopathy.

Main Methods:

  • Utilizing late gadolinium enhancement cardiovascular magnetic resonance to assess myocardial scar burden.
  • Analyzing studies on predictors of survival and graft selection in revascularization surgery.
  • Reviewing conventional, off-pump, minimal extracorporeal circulation, and hybrid revascularization approaches.

Main Results:

  • The transmural extent of myocardial scar, as determined by late gadolinium enhancement, predicts segmental functional recovery.
  • Coronary artery revascularization has demonstrated superiority in patients with poor left ventricular function.
  • Various surgical and medical strategies exist, with ongoing improvements in techniques and outcomes.

Conclusions:

  • Late gadolinium enhancement cardiovascular magnetic resonance is the gold standard for assessing myocardial viability and guiding revascularization in ischemic cardiomyopathy.
  • Surgical revascularization, including advanced techniques, offers significant benefits for selected patients.
  • Future directions focus on less invasive, safer coronary artery bypass grafting and novel therapeutic approaches.

Keywords:
coronary artery bypass graftingheart failurehybrid revascularisationleft ventricular reconstruction

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