Current Indications and Surgical Strategies for Myocardial Revascularization in Patients With Left Ventricular Dysfunction

Ischemic cardiomyopathy (ICM) causes more than 60 percent of congestive heart failure cases, leading to high morbidity and mortality. Myocardial revascularization is vital for patients with left ventricular dysfunction (LVD) and an ejection fraction (LVEF) ≤ 35 percent, aiming to improve survival rates and quality of life. Despite its importance, randomized clinical trials often exclude these patients, relying on observational data. A recent review evaluated surgical revascularization strategies, highlighting ONCABG for multivessel disease in LVD patients with LVEF < 35 percent, and OPCAB for older, high-risk patients. Techniques such as internal thoracic artery skeletonization, BITA, and postoperative glycemic control are crucial for managing risks. Total arterial revascularization improves long-term survival, while hybrid revascularization reduces hospital stays and costs. This review emphasizes the need for tailored revascularization strategies in severe LVD patients.