Chapter

Revascularization and remodelling surgery

John R. Pepper

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0050

Series: Oxford Textbooks

Revascularization and remodelling surgery

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There is a wide spectrum of clinical presentations of coronary heartdisease ranging from mild asymptomatic single-vessel disease,through multivessel disease with mild or moderate left ventriculardysfunction, to severe endstage ischaemic cardiomyopathy. As theseverity of left ventricular disease increases, so does the potential benefit of surgical intervention to the patient’s outcome. Unfortunately the clarity of the specific indications for coronary arterybypass grafting decreases. For example, in a patient with multivesselcoronary artery disease and moderate left ventricular dysfunction,the indications for coronary artery bypass grafting (CABG) are clear and well-defined by multiple large-scale prospective and retrospectivestudies. In contrast, for a patient with severe ischaemiccardiomyopathy and potentially graftable coronary arteries who isbeing evaluated for a variety of treatment options including medicaltreatment, resynchronization therapy, percutaneous coronaryintervention, coronary bypass grafting, valvular reconstruction,ventricular remodelling, mechanical assistance, and transplantation,the exact role of CABG is not so clear.Nevertheless, there is persuasive experimental and clinical evidencethat revascularization and perfusion of ischaemic or injuredmyocardium enhances cardiomyocyte integrity and contractility,thereby augmenting ventricular function. Thus the drive to revascularizeis strong. In this high-risk population, the challenge is toidentify those patients who will derive the most long-term benefitwhile incurring the least perioperative risk.

Chapter.  6196 words.  Illustrated.

Subjects: Cardiothoracic Surgery

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