ISCHEMIC CARDIOMYOPATHY - REVASCULARIZATION VS TRANSPLANTATION

Advanced coronary artery disease (CAD) and ischemic cardiomyopathy wit h elevated pulmonary artery pressures are criteria of a severe illness . In selected cases surgical revascularization has proved beneficial i n terms of survival, reduction of morbidity and lowering the frequency of angina pectoris [6] in numerous studies over the past 25 years. Bu t most of the earlier publications concentrated on patients with angin a pectoris (AP) as a dominant symptom. Patients without AP but with pr edominant signs of congestive heart failure were largely excluded. Thi s has changed recently [1-3,7,8,10,12,16,18] with the advent of the co ncept of hibernating myocardium. This term is defined as the presence of persistent myocardial and left ventricular dysfunction at rest due to reduced regional coronary blood flow that can be partially or compl etely restored to normal by myocardial revascularization [5,19]. Salva ge of viable myocardium by successful revascularization improves left ventricular dysfunction. Diagnosis of hibernating myocardium is crucia l because it does not leave the patient with chronic heart failure a c andidate only for cardiac transplantation. Instead, these patients' le ft ventricular dysfunction is potentially reversible following revascu larization by coronary bypass surgery. Furthermore we face a critical shortage of donor organs and extending waiting lists for possible tran splant candidates. Following the start of the heart transplantation (H TX) program at our institution more than 690 operations were performed until September 1995. We screened more than 1600 patients for their e ligibility as cardiac transplant recipients or for other forms of trea tment. In this group of patients it has always been our policy to reva scularize rather than transplant whenever possible. (C) 1997 Elsevier Science B.V.