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Review
. 2021 Feb;11(1):202-212.
doi: 10.21037/cdt-20-284.

Conventional cardiac surgery in patients with end-stage coronary artery disease: yesterday and today

Michal Szlapka  1 , Roland Hetzer  2 , Jürgen Ennker  3 , Harald Hausmann  1
Affiliations
Review

Conventional cardiac surgery in patients with end-stage coronary artery disease: yesterday and today

Michal Szlapka et al. Cardiovasc Diagn Ther. 2021 Feb.

Abstract

Surgical therapy of combined coronary artery disease (CAD) and heart failure, also referred to as end-stage CAD, has evolved throughout the years and patients are currently being offered traditional coronary artery bypass grafting (CABG), with or without surgical ventricle restoration (SVR), interventions for ischemic mitral valve regurgitation, heart transplantation or implantation of mechanical cardiovascular support systems. Among surgical methods, operative myocardial revascularization (with or without ventricle restoration) is still playing an important role, aiming at restoration of proper myocardial perfusion, especially if heart muscle viability is present. Facing the donor shortage, CABG may constitute a valuable alternative to transplantation in selected patients. In individuals considered not suitable for surgical revascularization, implantation of mechanical circulatory support (MCS) not only appears as a salvage procedure, but also allows for reevaluation of future therapy directions. This article aims at providing an overview of evolving and current surgical practices in patients with end-stage CAD.

Keywords: Coronary artery bypass grafting (CABG); end-stage coronary artery disease (CAD); heart transplantation ischemic cardiomyopathy; myocardial viability; surgical ventricle restoration (SVR).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure forms (available at http://dx.doi.org/10.21037/cdt-20-284). The series “Heart Failure in the Young and Old: Insights into Various Therapies” was commissioned by the editorial office without any funding or sponsorship. RH served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Cardiovascular Diagnosis and Therapy from July 2019 to Jun 2021. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Survival rates after CABG in patients with LVEF <30% in a high-volume European cardiac surgery center (German Heart Center Berlin, observational study on 2,158 patients, operated on between 1986 and 2003). CABG, coronary artery bypass grafting; LVEF, left ventricular ejection fraction.
Figure 2
Figure 2
Differences in long-term survival between patients undergoing surgical mitral valve repair vs. replacement for ischemic mitral valve insufficiency. pts., patients.
Figure 3
Figure 3
Influence of residual mitral valve insufficiency on survival at 7 years after mitral valve repair for ischemic mitral valve regurgitation. Observational study on 123 patients with ischemic mitral valve regurgitation. MI, mitral insufficiency.
See this image and copyright information in PMC

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References

    1. Topkara VK, Cheema FH, Kesavaramanujam S, et al. Coronary artery bypass grafting in patients with low ejection fraction. Circulation 2005;112:I344-50. - PubMed
    1. Hausmann H, Siniawski H, Meyer R, et al. Coronary artery bypass grafting in patients with highly impaired ventricular function. Long-term outcome. Dtsch Med Wochenschr 2002;127:2503-7. 10.1055/s-2002-35643 - DOI - PubMed
    1. Alderman EL, Fisher LD, Litwin P, et al. Results of coronary artery surgery in patients with poor left ventricular function (CASS). Circulation 1983;68:785-95. 10.1161/01.CIR.68.4.785 - DOI - PubMed
    1. Passamani E, Davis KB, Gillespie MJ, et al. A randomized trial of coronary artery bypass surgery. Survival of patients with a low ejection fraction. N Engl J Med 1985;312:1665-71. 10.1056/NEJM198506273122603 - DOI - PubMed
    1. McGee EC, Jr, McCarthy PM. Do patients with heart failure benefit from coronary artery bypass grafting? Curr Opin Cardiol 2012;27:629-33. 10.1097/HCO.0b013e328358b08d - DOI - PubMed

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