Title : Comprehensive surgical revascularization for rapidly worsening ischemic heart failure
Abstract:
Ischemic Heart Failure usually occurs due to delayed treatment of coronary artery disease. Rapidly worsening ischemic heart failure can occur due to Acute onset STEMI in a patient with critical multi vessel coronary artery disease with or without previously compromised left ventricular Ejection fraction. Majority of these patients may not be suitable for percutaneous interventions and Urgent Surgical Revascularization is lifesaving. Comprehensive Guidelines Directed Medical Therapy has complementary benefits which further reduces mortality as well as morbidity and significantly reduces risk of repeated hospitalization.
Methods: Between 1st July 2019 and 1st April 2025 we performed urgent Revascularization in 361 such patients 77 were having low risk Euro score (0-2), 115 had moderately high risk while remaining had high or very high risk (8 -80). Prompt Off pump surgical Revascularization was performed. Intraaortic balloon pump was inserted in hemodynamically unstable patients with high pulmonary artery pressure and when mean arterial blood pressure was not achievable despite maximum inotropes or in presence of intractable ventricular arrhythmias. GDMT was initiated early and Variciguat was added those patients who could not be optimized with GDMT or where it could not be initiated to the desired levels due to comorbidities.
Result: Post Operative hospital stay was 3. 2 days in low-risk group, 4.6 days in moderate risk and 7.3 in high risk. Need for IABP insertion was also very low and there were only 2 conversions to pump due to Cardiac arrest refractory to open Cardiac massage. There was significant improvement in LVEF in all patients and Mitral regurgitation which was moderate to severe was reduced to mild to trivial. Mortality was 0 in low-risk patients, 1 in moderate and 3 in high and very high risk and worsening renal failure was associated with mortality in 2. The total expenses were 19.4 % less than expected in low-risk patients while in high risk it was 50% less.
Conclusion: Comprehensive GDMT along with Off pump Surgical Revascularization shortens hospital stay, reduces IABP requirement, Reduces MR, improves LVEF and drastically reduces Mortality and Mortality in patients with rapidly worsening Heart failure.
