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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© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
