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

Ischemic cardiomyopathy (ICM) accounts for more than 60 percent of congestive heart failure cases and is associated with significant morbidity and mortality. Myocardial revascularization in patients with left ventricular dysfunction (LVD) and a left ventricular ejection fraction (LVEF ≤35 percent) is intended to improve survival and quality of life. Most randomized clinical trials, however, have excluded these patients, leaving the evidence base primarily observational. A scoping review, using the Arksey and O’Malley methodology, examined surgical revascularization strategies in adults with ischemic LVD (LVEF ≤35 percent). After screening 385 references, 156 were selected, with 134 deemed suitable for review. The review addressed current knowledge, surgical strategies (off-pump vs on-pump), and graft options for revascularization. Findings suggest that coronary revascularization is beneficial in LVD (LVEF <35 percent) with ONCABG preferred for multivessel disease and OPCAB recommended for older, high-risk patients.