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Revascularization in left ventricular dysfunction: an update

Bobby Yanagawa1, Jessica Lee1, John D Puskas2

  • 1Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Current Opinion in Cardiology
|August 9, 2019
PubMed

Insights

Surgical revascularization improves long-term survival for patients with coronary artery disease and left ventricular dysfunction. Coronary artery bypass grafting offers better outcomes than percutaneous coronary revascularization in this high-risk group.

Area of Science:

  • Cardiology
  • Cardiac Surgery

Background:

  • Patients with coronary artery disease (CAD) and left ventricular dysfunction (LVD) represent a high-risk population.
  • The Surgical Treatment for Ischemic Heart Failure (STICH) Trial is a key study in this area.

Purpose of the Study:

  • To review revascularization strategies for patients with CAD and LVD.
  • To evaluate the comparative effectiveness of surgical versus percutaneous revascularization.

Main Methods:

  • Review of major prospective trials, including the STICH Trial.
  • Analysis of observational studies comparing coronary artery bypass grafting (CABG) and percutaneous coronary revascularization (PCI).

Main Results:

  • The STICH Trial showed lower all-cause mortality with surgical revascularization compared to medical therapy at 10 years.
  • Observational data indicate CABG superiority over PCI for long-term survival and reduced need for repeat procedures in LVD patients.
  • Surgical revascularization has short-term risks but offers improved long-term outcomes for LVD patients.

Conclusions:

  • Surgical revascularization provides a long-term survival benefit for patients with significant CAD and LVD.
  • Consideration for multiarterial grafting and off-pump procedures may benefit selected LVD patients undergoing CABG.
  • Further research is needed to identify optimal candidates for surgical versus percutaneous revascularization.
Abstract

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