52
Surgical/Percutaneous/Transcatheter Interventional
Treatments of HF (see Tables 34 and 35)
Î Coronary 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)
Î CABG 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)
Î CABG 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)
Î Surgical aortic valve replacement is reasonable for patients with
critical aortic stenosis and a predicted surgical mortality of <10%.
(IIa-B)
Î Transcatheter aortic valve replacement after careful candidate
consideration is reasonable for patients with critical aortic stenosis
who are deemed inoperable. (IIa-B)
Î CABG 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)
Î Transcatheter 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)
Î Surgical 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)
Treatment
