Selection of appropriate patients with heart failure for aortocoronary bypass surgery.

There is a slowly increasing amount of information on surgical revascularization of high-risk patients with lower ejection fractions. Many of these patients, formerly thought to be best treated by transplantation, can undergo safe and effective revascularization with excellent medium-term results. Factors that are important in predicting the success of surgical revascularization include left ventricular dilitation, elevated left ventricular end-diastolic pressure, redo coronary surgery, depressed white ventricular function, the presence of mitral regurgitation, and the presence of associated systemic diseases, among others. The management of patients with low ejection fraction around the time of coronary surgery is of critical importance; a period of pre-operative "tune-up" in the hospital on intravenous pressures, intra-aortic balloon, counter pulsation, and the use of transesophageal echocardiography, and improved intra-operative myocardial protection techniques have all contributed to improved results. The improvement in mechanical cardiac systems has also contributed toward improved surgical outcomes in this high-risk patient group.