Surgical options in ischemic cardiomyopathy.
The prevalence of ischemic dilated cardiomyopathy in western countries is increasing despite improvements in prevention, diagnosis, and treatment of cardiovascular disease. The management of patients with coronary artery disease and severe left ventricular dysfunction continues to be challenging and the mortality rate with medical therapy alone in this setting remains very high. Since heart transplantation represents a realistic option just for a very small number of patients, in recent years a variety of classic surgical interventions have been improved or optimized to address the complex and multifactorial pathophysiology of the ischemic heart failure picture. Myocardial revascularization, left ventricular restoration, mitral valve repair, passive containment device implantation, and surgical ablation of atrial fibrillation represent some of the "conventional" procedures which are currently in use or under development for the surgical treatment of ischemic cardiomyopathy. For several of them, the exact indications and results are not yet established and significant changes and improvements should reasonably be waited over the next few years. As techniques are refined and more data become available, the optimum surgical strategy for patients with advanced ischemic heart failure is likely to become clearer and more effective.
De Bonis
Michele
M
Department of Cardiac Surgery, Vita e Salute University, San Raffaele Hospital, Milan, Italy. michele.debonis@hsr.it
Lapenna
Elisabetta
E
Ficarra
Eleonora
E
La Canna
Giovanni
G
Verzini
Alessandro
A
Pagliaro
Marco
M
Castiglioni
Alessandro
A
Maisano
Francesco
F
Torracca
Lucia
L
Benussi
Stefano
S
Alfieri
Ottavio
O
D001281:Atrial Fibrillation / Q000601:surgery; D009202:Cardiomyopathies / Q000209:etiology / Q000601:surgery*; D006333:Heart Failure / Q000601:surgery; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery; D017202:Myocardial Ischemia / Q000209:etiology / Q000601:surgery*; D009204:Myocardial Revascularization; D018487:Ventricular Dysfunction, Left / Q000601:surgery