title: Revascularization in severe left ventricular dysfunction.
abstract: The highest-risk patients with heart failure with reduced ejection fraction are those with ischemic cardiomyopathy and severe left ventricular systolic dysfunction (ejection fraction≤35%). The cornerstone of treatment is guideline-driven medical therapy for all patients and implantable device therapy for appropriately selected patients. Surgical revascularization offers the potential for improved survival and quality of life, particularly in patients with more extensive multivessel disease and the greatest degree of left ventricular systolic dysfunction and remodeling. These are also the patients at greatest short-term risk of mortality with coronary artery bypass graft surgery. The short-term risks of surgery need to be balanced against the potential for long-term benefit. This review discusses the evolving data on the role of surgical revascularization, surgical ventricular reconstruction, and mitral valve surgery in this high-risk patient population.
authors: Department of Medicine-Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors: Eric J
authors: EJ
authors: Velazquez
authors: Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: r-bonow@northwestern.edu.
authors: Robert O
authors: RO
authors: Bonow
mesh_terms: D004452:Echocardiography; D006801:Humans; D009204:Myocardial Revascularization / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D016277:Ventricular Function, Left
keywords: coronary artery bypass grafting; coronary artery disease; heart failure