Invasive or Surgical Management
Patients with CHD, the leading cause of CHF, may benefit from coronary revascularization by either CABG or PCI. Depending on the underlying causes, other surgical procedures that may be helpful in CHF include percutaneous balloon valvuloplasty, mitral or aortic valve replacement, and pericardiectomy. Left ventricular reconstruction to reduce the volume of a dilated left ventricle has been performed but has not had favorable outcomes in the STICH and other trials. Cardiac transplantation can be an effective surgical treatment for patients with refractory or end-stage CHF, but the availability of organs and facilities is limited. Many transplant centers have achieved a 1-year survival rate that exceeds 85% for a first graft. Implantable ventricular assist devices may help to maintain patients awaiting cardiac transplantation.
Finally, because many patients with advanced CHF are older and have multiple comorbidities, palliative care directed only at symptomatic improvement should also be considered.
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129–2200.
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure. J Am Coll Cardiol. 2013;62(16):e147–e239.
Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. J Am Coll Cardiol. 2017;70(6):776–803.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.