Ramallal Raúl

Heart failure with reduced ejection fraction (HFrEF) is a major contributor to cardiovascular morbidity and mortality, with ischemic heart disease as the leading etiology. Despite advances in optimal medical treatment (OMT), the additional benefit of coronary revascularization in this population remains uncertain. While some studies describe a potential benefit in revascularization—particularly with coronary artery bypass grafting (CABG)—this benefit has not been consistently observed with percutaneous coronary intervention (PCI). Moreover, in this context, the role of myocardial hibernation has been called into question. Additionally, recent advances in the medical management of heart failure complicate the current interpretation of previous studies and underscore the need for new clinical trials. This review synthesizes the current evidence on the potential benefits of coronary revascularization in patients with heart failure with reduced ejection fraction (HFrEF).

Heart failure with reduced ejection fraction (HFrEF) is a major contributor to cardiovas-cular morbidity and mortality, with ischemic heart disease as the leading etiology. Despite advances in optimal medical treatment (OMT), the additional benefit of coronary revascularization in this population remains uncertain. While some studies describe a potential benefit in revascularization - particularly with coronary artery bypass grafting (CABG)- this benefit has not been consistently observed with percutaneous coronary intervention (PCI). Moreover, in this context, the role of myocardial hibernation has been called into question. Additionally, recent advances in the medical management of heart failure complicate the current interpretation of previous studies and underscores the need for new clinical trials

Background and Objectives: Transcatheter Aortic Valve Replacement (TAVR) has revolutionized the management of severe aortic stenosis (AS), offering a less invasive alternative to surgical replacement, which is particularly beneficial for elderly and high-risk populations. This narrative review aims to summarize current evidence regarding TAVR’s clinical outcomes, patient selection, the role of cardiac remodeling, and the impact of geriatric syndromes on procedural success. Materials and Methods: This review is based on a comprehensive analysis of the peer-reviewed literature indexed in major scientific databases. We included relevant studies addressing TAVR in older adults, focusing on cardiac biomarkers, imaging, patient stratification, and geriatric syndromes, such as frailty, delirium, and sarcopenia. Results: Evidence indicates that TAVR significantly improves survival and quality of life in elderly patients with severe AS. Advanced cardiac imaging and biomarkers contribute to improved risk stratification and post-procedural management. Geriatric syndromes are prevalent in this population and strongly influence clinical outcomes. Tailored prehabilitation and multidisciplinary approaches are increasingly recognized as critical components of TAVR care. Conclusions: TAVR is an effective and safe option for older adults with severe AS. Optimal outcomes depend not only on procedural expertise but also on recognizing and addressing the complex interplay between cardiac pathology and geriatric vulnerabilities. A holistic, patient-centered approach is essential to maximize the therapeutic benefits in this growing patient population.