Coronary Arteries Bypass Grafting as a Salvage Surgery in Ischemic Heart Failure

Abstract

Ischemic cardiomyopathy accounts for approximately two-thirds of all Heart Failure (HF) cases. Recent studies indicates that revascularization provides superior outcomes compared with optimal medical therapy (OMT) alone. Current European and American guidelines recommend an invasive approach in patients with reduced left ventricular ejection fraction (LVEF) less than 35% and with multivessel disease (MVD). Randomized controlled trials in these patients have proven that long-term survival is greater following coronary artery bypass grafting (CABG) than with OMT alone. Patients with ischemic cardiomyopathy and coronary artery disease that is amenable to surgical revascularization should undergo combination of surgical revascularization and medical therapy rather than medical therapy alone. In some cases, combined CABG with other surgeries are vital salvage procedures, such as atrial fibrillation, mitral valve, tricuspid valve, and LV remodeling. Based on small but, nontrivial, early mortality risk associated with CABG surgery as well as other post-CABG morbidities, patients may also reasonably choose medical therapy as initial treatment option. Revascularization remains an important treatment option for patients with ongoing anginal symptoms despite optimal medical therapy. In this chapter, we will highlight the role of CABG in heart failure treatment and when to use it as a salvage surgery before referring the patient for heart transplantation.