Recommendations for Surgical/Percutaneous/Transcatheter Interventional Treatments of HF Recommendations COR LOE References CABG or percutaneous intervention is indicated for HF patients on GDMT with angina and suitable coronary anatomy, especially significant left main stenosis or left main equivalent I C 11,13,15,348 CABG to improve survival is reasonable in patients with mild to moderate LV systolic dysfunction and significant multivessel CAD or proximal LAD stenosis when viable myocardium is present IIa B 348 350 CABG or medical therapy is reasonable to improve morbidity and mortality for patients with severe LV dysfunction (EF <35%), HF, and significant CAD IIa B 351,352 Surgical aortic valve replacement is reasonable for patients with critical aortic stenosis and a predicted surgical mortality of no greater than 10% IIa B 353 Transcatheter aortic valve replacement is reasonable for patients with critical aortic stenosis who are deemed inoperable IIa B 354 CABG may be considered in patients with ischemic heart disease, severe LV systolic dysfunction, and operable coronary anatomy whether or not viable myocardium is present IIb B 352,355,356 Transcatheter mitral valve repair or mitral valve surgery for functional mitral insufficiency is of uncertain benefit IIb B 357 360 Surgical reverse remodeling or LV aneurysmectomy may be considered in HFrEF for specific indications, including intractable HF and ventricular arrhythmias IIb B 361 CABG indicates coronary artery bypass graft; CAD, coronary artery disease; COR, Class of Recommendation; EF, ejection fraction; GDMT, guideline-directed medical therapy; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; LAD, left anterior descending; LOE, Level of Evidence; and LV, left ventricular. Yancy et al. JACC Vol. 62, No. 16, 2013 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary October 15, 2013:1495 539 insuf ciency, diabetes mellitus, or chronic lung disease with the HF syndrome should logically require a modi cation of treatment, outcome assessment, or follow-up care. 