Surgical Therapies for Post-Myocardial Infarction Patients

  • Patrick M. McCarthy
    Address for reprints: Patrick M. McCarthy, MD, Division of Cardiothoracic Surgery, Feinberg School of Medicine, Northwestern University, 201 East Huron Street, Suite 11-140, Chicago, Illinois 60611-2908
    Division of Cardiothoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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      Occasionally, high-risk patients in the post-myocardial infarction (MI) period require surgical intervention for stabilization and/or revascularization. In a meta-analysis involving 3,088 patients with ischemic heart disease, revascularization was associated with nearly an 80% reduction in the risk of death. Coronary artery bypass graft (CABG) surgery is commonly performed in post-MI patients and is associated with more favorable outcomes than medical therapy. However, several factors have to be considered in proper patient selection for CABG, such as the left ventricular ejection fraction (LVEF), severity of heart failure (HF), and myocardial viability. The ongoing Surgical Treatment for Ischemic Heart Failure (STICH) trial will assess the benefits of CABG in patients with both a low LVEF and HF. Unstable post-MI patients who fail revascularization can be managed via mechanical circulatory support devices or pumps. These options significantly improve hemodynamic parameters. In addition, other surgical techniques, such as mitral valve repair, ventricular reconstruction surgery, and atrial fibrillation ablation, are being evaluated in patients with ischemic heart disease.
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        • Hochman J.S.
        • Sleeper L.A.
        • Webb J.G.
        • Sanborn T.A.
        • White H.D.
        • Talley J.D.
        • Buller C.E.
        • Jacobs A.K.
        • Slater J.N.
        • Col J.
        • McKinlay S.M.
        • LeJemtel T.H.
        Early revascularization in acute myocardial infarction complicated by cardiogenic shock.
        N Engl J Med. 1999; 341: 625-634
        • Burkhoff D.
        • Cohen H.
        • Brunckhorst C.
        • O'Neill W.W.
        A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock.
        Am Heart J. 2006; 152: 469.e1-469.e8
        • Tayara W.
        • Starling R.C.
        • Yamani M.H.
        • Wazni O.
        • Jubran F.
        • Smedira N.
        Improved survival after acute myocardial infarction complicated by cardiogenic shock with circulatory support and transplantation: comparing aggressive intervention with conservative treatment.
        J Heart Lung Transplant. 2006; 25: 504-509
      1. Society of Thoracic Surgeons database.

        • McCarthy P.M.
        Surgical management of heart failure.
        in: Libby P.L. Bonow R.O. Zipes D. Mann D.L. Braunwald's Heart Disease. 8th ed. Elsevier Scientific, Philadelphia2007
        • Starling R.C.
        • McCarthy P.M.
        • Yamani M.H.
        Surgical treatment of chronic congestive heart failure.
        in: Mann D.L. Heart Failure: A Companion to Braunwald's Heart Disease. Saunders, Philadelphia2004: 717-736
        • Shapira O.M.
        • Hunter C.T.
        • Anter E.
        • Bao Y.
        • DeAndrade K.
        • Lazar H.L.
        • Shemin R.J.
        Coronary artery bypass grafting in patients with severe left ventricular dysfunction: early and mid-term outcomes.
        J Card Surg. 2006; 21: 225-232
        • Darwazah A.K.
        • Abu Sham'a R.A.
        • Hussein E.
        • Hawari M.H.
        • Ismail H.
        Myocardial revascularization in patients with low ejection fraction ≤35%: effect of pump technique on early morbidity and mortality.
        J Card Surg. 2006; 21: 22-27
        • O'Connor C.M.
        • Velazquez E.J.
        • Gardner L.H.
        • Smith P.K.
        • Newman M.F.
        • Landolfo K.P.
        • Lee K.L.
        • Califf R.M.
        • Jones R.H.
        Comparison of coronary artery bypass grafting versus medical therapy on long-term outcome in patients with ischemic cardiomyopathy (a 25-year experience from the Duke Cardiovascular Disease Databank).
        Am J Cardiol. 2002; 90: 101-107
        • Joyce D.
        • Loebe M.
        • Noon G.P.
        • McRee S.
        • Southard R.
        • Thompson L.
        • Skrabal C.
        • Youker K.
        • Torre-Amione G.
        Revascularization and ventricular restoration in patients with ischemic heart failure: the STICH trial.
        Curr Opin Cardiol. 2003; 18: 454-457
        • Di Carli M.F.
        • Asgarzadie F.
        • Schelbert H.R.
        • Brunken R.C.
        • Laks H.
        • Phelps M.E.
        • Maddahi J.
        Quantitative relation between myocardial viability and improvement in heart failure symptoms after revascularization in patients with ischemic cardiomyopathy.
        Circulation. 1995; 92: 3436-3444
        • Allman K.C.
        • Shaw L.J.
        • Hachamovitch R.
        • Udelson J.E.
        Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis.
        J Am Coll Cardiol. 2002; 39: 1151-1158
        • Clappers N.
        • Verheugt F.W.A.
        Hotline session of the 28th European Congress of Cardiology/World Congress of Cardiology 2006.
        Eur Heart J. 2006; 27: 2896-2899
        • McCarthy P.M.
        Valve surgery for patients with left ventricular dysfunction.
        in: McCarthy P.M. Young J.B. Heart Failure: A Combined Medical and Surgical Approach. Blackwell Futura, Malden, Mass2007: 153-173
        • McCarthy P.M.
        • McGee Jr, E.C.
        Ventricular reconstruction and device therapies for cardiomyopathy patients.
        in: McCarthy P.M. Young J.B. Heart Failure: A Combined Medical and Surgical Approach. Blackwell Futura, Malden, Mass2007: 174-191
        • Lam B.K.
        • Gillinov A.M.
        • Blackstone E.H.
        • Rajeswaran J.
        • Yuh B.
        • Bhudia S.K.
        • McCarthy P.M.
        • Cosgrove D.M.
        Importance of moderate ischemic mitral regurgitation.
        Ann Thorac Surg. 2005; 79 (discussion 469–470): 462-468
        • Mallidi H.R.
        • Pelletier M.P.
        • Lamb J.
        • Desai N.
        • Sever J.
        • Christakis G.T.
        • Cohen G.
        • Goldman B.S.
        • Fremes S.E.
        Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting.
        J Thorac Cardiovasc Surg. 2004; 127: 636-644
        • Daimon M.
        • Fukuda S.
        • Adams D.H.
        • McCarthy P.M.
        • Gillinov A.M.
        • Carpentier A.
        • Filsoufi F.
        • Abascal V.M.
        • Rigolin V.H.
        • Salzberg S.
        • et al.
        Mitral valve repair with Carpentier-McCarthy-Adams IMR ETlogix annuloplasty ring for ischemic mitral regurgitation: early echocardiographic results from a multi-center study.
        Circulation. 2006; 114: I-588-I-593
        • O'Neill J.O.
        • Starling R.C.
        • McCarthy P.M.
        • Albert N.M.
        • Lytle B.W.
        • Navia J.
        • Young J.B.
        • Smedira N.
        The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy.
        Eur J Cardiothorac Surg. 2006; 30: 753-759
        • Mahon N.G.
        • O'Neill J.O.
        • Young J.B.
        • Bennett R.
        • Hoercher K.
        • Banbury M.K.
        • Navia J.L.
        • Smedira N.G.
        • McCarthy P.M.
        • Starling R.C.
        Contemporary outcomes of outpatients referred for cardiac transplantation evaluation to a tertiary heart failure center: impact of surgical alternatives.
        J Card Fail. 2004; 10: 273-278
        • Calkins H.
        • Brugada J.
        • Packer D.L.
        • Cappato R.
        • Chen S.A.
        • Crijns H.J.
        • Damiano Jr, R.J.
        • Davies D.W.
        • Haines D.E.
        • Haissaguerre M.
        • et al.
        HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up.
        Heart Rhythm. 2007; 4: 816-861
        • Athanasuleas C.L.
        • Buckberg G.D.
        • Stanley A.W.
        • Siler W.
        • Dor V.
        • Di Donato M.
        • Menicanti L.
        • Almeida de Oliveira S.
        • Beyersdorf F.
        • Kron I.L.
        • et al.
        Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation.
        J Am Coll Cardiol. 2004; 44: 1439-1445