Coronary artery bypass grafting in the treatment of heart failure

Heart failure remains a major medical burden with an estimated six million people affected in the United States of America alone making it the most common diagnosis in all hospital admissions [1, 2]. Coronary artery disease (CAD) with subsequent ischemic cardiomyopathy is the underlying cause of heart failure in roughly 70 % of all heart failure patients [3]. Indeed, myocardial infarctions (MI) are responsible for 750,000 deaths annually with an estimated 60,000 of the survivors developing congestive heart failure [4]. Transplantation has traditionally been the only surgical treatment for end stage heart failure but the scarcity of donor organs, the recipient suitability for organ transplantation as well as the rapid rise of heart failure have made this less than an ideal solution for all. Increasingly, surgical intervention has concentrated on coronary revascularization, valvular repair/replacement, ventricular restoration/remodeling, ventricular assist devices, stem cell therapy and external restraint devices [4, 5]. In this chapter, we aim to highlight the utility and selection of offering revascularization to the subgroup of heart failure patients who will benefit from this intervention.