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CABG in patients with left ventricular dysfunction: indications, techniques and outcomes

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Ischemic chronic heart failure (CHF) represents one of the cardiovascular diseases with the worst degree of morbidity and mortality in the western world, and with the highest health care costs. Despite several studies demonstrated that surgical revascularization (CABG), especially in the presence of viable myocardium, improve heart function, and therefore, survival, the matter remains unclear and controversial. In the late 1970s, the Coronary Artery Surgery Study showed that a subgroup of patients with coronary artery disease, angina, and reduce LV function had a significant survival benefit after CABG compared to those treated medically. The key concept behind this observation was the presence of viable myocardium, which can resume function following revascularization. In contrary, the surgical treatment for ischemic heart failure (STICH) trial, which randomized patients with CAD and LV dysfunction to evidence-based medical therapy or CABG plus medical therapy, failed to demonstrate at a median follow-up of 56 months a significant difference between the CABG group and the medical therapy group in the rate of death from any cause. However, the results of the STICH extension study (STICHES) at 10 years follow-up demonstrated that CABG is associated with a significant reduction in all-cause mortality, cardiovascular mortality, and readmission for heart compared to optimal medical therapy (OMT) in patients with severe ischemic LV dysfunction. Therefore, this review discusses the available evidences in literature, from observational studies to randomized trials, including operative techniques and controversial issues, in order to better clarify the role of CABG in the current management of ischemic patients with LVD.

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Authors and Affiliations

  1. Department of Cardiovascular Disease “E. Malan”, Cardiac Surgery Unit, IRCCS Policlinico S. Donato Hospital, San Donato Milanese, Via Morandi 30, 20097, Milan, Italy

    Andrea Garatti, Serenella Castelvecchio, Alberto Canziani & Lorenzo Menicanti

  2. Division of Cardiology, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy

    Tiberio Santoro

Authors
  1. Andrea Garatti
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  2. Serenella Castelvecchio
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  3. Alberto Canziani
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  4. Tiberio Santoro
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  5. Lorenzo Menicanti
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Correspondence to Andrea Garatti.

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The manuscript is original and has not been published previously (partly or in full). No data have been fabricated or manipulated. Consent to submit has been received explicitly from all co-authors. Authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results.

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The authors declare that they have no conflict of interest.

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Garatti, A., Castelvecchio, S., Canziani, A. et al. CABG in patients with left ventricular dysfunction: indications, techniques and outcomes. Indian J Thorac Cardiovasc Surg 34 (Suppl 3), 279–286 (2018). https://doi.org/10.1007/s12055-018-0738-8

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  • DOI: https://doi.org/10.1007/s12055-018-0738-8

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