Best of heart failure

26 Curr Treat Options Cardio Med (2019) 21: 4 DOI 10.1007/s11936-019-0708-5 Coronary Artery Disease (D Feldman and V Voudris, Section Editors) Revascularization in Cardiogenic Shock and Advanced Heart Failure Youssef Rahban, MD Carlos D. Davila, MD Peter S. Natov, BS Navin K. Kapur, MD * Address * The Cardiovascular Center, Tufts Medical Center, Boston, MA, 02111, USA Email: Nkapur@tuftsmedicalcenter.org Published online: 7 February 2019 * Springer Science+Business Media, LLC, part of Springer Nature 2019 Youssef Rahban and Carlos D. Davila contributed equally to this work. This article is part of the Topical Collection on Coronary Artery Disease Keywords Coronary artery disease I Cardiogenic shock I Heart failure I Interventional heart failure Abstract Purpose of review Ischemic heart disease is the most common cause of heart failure with systolic dysfunction. The progressive course of heart failure characterized by increasing levels of care and worsening quality of life often indicates an advanced stage. Similarly, cardiogenic shock remains a major clinical problem with prohibitively high mortality rates despite major advances in clinical care. Here, we review the current treatment options and available data for revascularization in patients with ischemic cardiomyopathy, advanced heart failure, and cardiogenic shock. We also explore the emerging role of Interventional Heart Failure specialist within the Heart Team. Recent findings Although guideline-directed medical therapy remains the cornerstone treatment strategy for patients with advanced heart failure, coronary revascularization is sometimes indicated. There is a relatively paucity of evidence regarding different revascu- larization strategies and the use of acute mechanical circulatory support in patients with advanced heart failure and in those presenting with cardiogenic shock. A deep understating of the physiologic and hemodynamic effects of different acute mechanical support plat- forms is of paramount importance in preparation for revascularization in these patients. Summary The decision regarding revascularization in patients with coronary artery disease in the setting of left ventricular dysfunction remains challenging. Clinical decision-making in these cases requires interdisciplinary discussion and assessment of the potential long- term survival derived from surgical revascularization against its higher perioperative risk.