Revascularization Surgery as a Treatment Concept for Heart Failure

Patients with heart failure symptoms due to ischemic cardiomyopathy face a poor prognosis without adequate treatment. In these patients with viable ischemic myocardium, revascularization surgery is not a new but an established treatment concept. The CASS study, published in 1983, was already able to document the superiority of coronary artery revascularization in patients with poor left ventricular function. It is of utmost importance to predict regional functional recovery in order to assess viability and, thus, the indication for revascularization. Late gadoliniium enhancement cardiovascular magnetic resonance is the new gold standard. By applying this technique, it can be demonstrated that the transmural extent of a scar predicts segmental functional recovery. Numerous studies describe the predictors of survival of surgical revascularization, the indication and impact of medical antiarrhythmic treatment or choice of graft. In addition to conventional surgery, off-pump procedures, minimal extracorporeal circulation and hybrid revascularization have a special role in the treatment of patients with ischemic cardiomyopathy. Surgical techniques and medical therapies continue to improve. The future revascularization in these patients will focus on improving results and making coronary artery bypass grafting for elective revascularization less invasive and safer. Technical evolution, including the use of robotics and anastomotic connectors, intraoperative imaging and protein enzyme therapies, have to be defined concerning their special impact in these patients.