Role of cardiac surgery in the post-myocardial infarction patient with heart failure.
Limited donor availability for orthotopic cardiac transplantation has led surgeons to develop surgical alternatives to treat congestive heart failure as a result of ischemic cardiomyopathy. Coronary revascularization plays a clear role in patients with ischemic cardiomyopathy, substantial viable myocardium subtended by coronary stenoses, and presence of anginal symptoms. It is unclear whether patients with heart failure symptoms but no angina benefit from bypass surgery. Some of these patients present with left ventricular dilatation and akinetic/dyskinetic scars, and are therefore candidates for surgical ventricular restoration. Current evidence is lacking as to whether ventricular reconstruction should be performed along with coronary revascularization. Functional mitral regurgitation is often seen in patients with end-stage cardiomyopathy, and its presence portends decreased survival. Mitral valve repair has been shown to improve quality of life, functional class, and to contribute to left ventricle reverse remodeling; however, it has been insufficient in improving survival.
Leacche
Marzia
M
Vanderbilt Heart and Vascular Institute, Department of Cardiac Surgery, 1215 21st Avenue South, MCE 5th Floor, South Tower, Nashville, TN 37232, USA.
Balaguer
Jorge M
JM
Byrne
John G
JG
D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D006333:Heart Failure / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008944:Mitral Valve Insufficiency / Q000601:surgery; D009203:Myocardial Infarction / Q000150:complications*; D018487:Ventricular Dysfunction, Left / Q000601:surgery