Surgical/Percutaneous/Transcatheter Interventional
Treatments of HF (see Tables 27 and 28)
ÎÎCoronary artery revascularization via coronary artery bypass graft
(CABG) or percutaneous intervention is indicated for patients (HFpEF
and HFr EF) on GDMT with angina and suitable coronary anatomy,
especially for a left main stenosis (>50%) or left main–equivalent
disease. (I-C)
ÎÎCABG to improve survival is reasonable in patients with mild to
moderate LV systolic dysfunction (EF 35%–50%) and significant
(≥70% diameter stenosis) multivessel CAD or proximal left anterior
descending (LAD) coronary artery stenosis when viable myocardium is
present in the region of intended revascularization. (IIa-B)
ÎÎCABG or medical therapy is reasonable to improve morbidity and
cardiovascular mortality for patients with severe LV dysfunction (EF
<35%), HF, and significant CAD. (IIa-B)
ÎÎSurgical aortic valve replacement is reasonable for patients with
critical aortic stenosis and a predicted surgical mortality of no greater
than 10%. (IIa-B)
ÎÎTranscatheter aortic valve replacement after careful candidate
consideration is reasonable for patients with critical aortic stenosis
who are deemed inoperable. (IIa-B)
ÎÎCABG may be considered with the intent of improving survival
in patients with ischemic heart disease with severe LV systolic
dysfunction (EF <35%) and operable coronary anatomy whether or not
viable myocardium is present. (IIb-B)
ÎÎTranscatheter mitral valve repair or mitral valve surgery for functional
mitral insufficiency is of uncertain benefit and should only be
considered after careful candidate selection and with a background of
GDMT. (IIb-B)
ÎÎSurgical reverse remodeling or LV aneurysmectomy may be considered
in carefully selected patients with HFr EF for specific indications
including intractable HF and ventricular arrhythmias. (IIb-B)
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