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Surgical Turndown: "What's in a Name?" for Patients Deemed Ineligible for Surgical Revascularization

Hung Q Ly1, Mohamed Nosair1, Raymond Cartier2

  • 1Interventional Cardiology Division, Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Quebec, Canada.

The Canadian Journal of Cardiology
|August 5, 2019
PubMed

Insights

Managing patients with severe ischemic heart disease (SIHD) ineligible for surgery, termed surgical turndown, presents challenges. A comprehensive Heart Team approach is crucial for optimal revascularization and improved outcomes in this growing patient group.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Severe ischemic heart disease (SIHD) management is guided by clinical guidelines.
  • An aging population and increasing comorbidities lead to a rise in SIHD patients ineligible for surgical revascularization (surgical turndown).
  • Surgical turndown status is linked to poorer clinical outcomes and adverse prognostic implications.

Purpose of the Study:

  • To review the significance of the surgical turndown diagnosis in SIHD.
  • To analyze the impact of surgical turndown on clinical outcomes.
  • To identify key factors for revascularization decision-making in this patient subgroup.

Main Methods:

  • Review of clinical guidelines and literature concerning SIHD management.
  • Analysis of prognostic implications associated with surgical turndown.
  • Discussion of factors influencing revascularization suitability, including frailty and completeness of revascularization.
  • Emphasis on the integrated Heart Team approach for patient-centered care.

Main Results:

  • Surgical turndown patients face worse clinical outcomes compared to those eligible for surgery.
  • Frailty and the potential for complete revascularization are critical considerations in decision-making.
  • The Heart Team approach facilitates comprehensive assessment and tailored treatment strategies.

Conclusions:

  • Accurate diagnosis and assessment of surgical turndowns are paramount in SIHD.
  • An integrated Heart Team is essential for optimizing revascularization strategies in complex SIHD patients.
  • Careful consideration of patient-specific factors is vital for improving outcomes in surgical turndown patients.

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