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J.Jpn. Surg. Soc.. 115(5): 253-258, 2014

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Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan

Atsushi Yamaguchi

The prognosis of patients with ischemic cardiomyopathy after medical treatment remains poor, despite advances in various therapeutic strategies. In addition to the poorer prognosis, they face higher operative risk, and complex, unestablished operative procedures should be addressed when obtaining preoperative informed consent from patients with ischemic cardiomyopathy. Although the established indications for revascularization in patients with ischemic heart failure pertain to those with angina and significant coronary artery disease, the management of patients with ischemic heart failure without angina is a challenge because of the lack of evidence in this population. The possibility of combining myocardial revascularization with surgical ventricular reconstruction (SVR) to reverse left ventricular remodeling or with mitral valve plasty to repair the incompetence of mitral valve coaptation has been examined in many trials, although little difference in the long-term outcomes between the simple revascularization and the combined procedure groups have been observed. The therapeutic guidelines for patients with ischemic cardiomyopathy state that choosing to add SVR and/or mitral surgery to revascularization should be based on a precise, careful evaluation and should be performed only by surgeons with a high level of surgical expertise.

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