Revascularization options for ischemic cardiomyopathy: on-pump and off-pump coronary artery bypass surgery.

Patients with ischemic cardiomyopathy and markedly reduced left ventricular (LV) function should be evaluated for coronary artery bypass surgery (CABG) before other surgical options are considered. The success of surgery depends on the presence of viable myocardium and target coronary arteries of acceptable quality. Long-term survival in this setting may be comparable to that with cardiac transplantation. Off-pump CABG can be safely and reproducibly performed in patients with diminished LV function. Off-pump beating heart surgery may provide additional benefits to these patients by reducing some of the complications that are associated with cardiopulmonary bypass.