I would have better appreciated a nerve blockage technique, but if you are able to avoid the decrease of blood pressure after initial anaesthesia, also spinal can be a reasonable choice.

I am an anaesthetist

This case offers an example of good anaesthetic management.

Anaesthetic management of patients with cardiomyopathy with reduced systolic function may be associated with high mortality. Thus, I agree with the choice of avoiding general anaesthesia as it depresses central nervous system function and also cardiac function. In fact, in these cases you must absolutely avoid the depression of the myocardium.

In the hospital in which I work we prefer to manage these patients with the help of nerve blocks ( through double guidance N.E.S. plus U.S. ) but sometimes we opt for spinal anaesthesia too ( it depends on post-operative pain level prediction as we experienced a better post operative pain relief with nerve blocks ).

Lots of anaesthesia practised for orthopedic surgery at my hospital in Rome