Surgical Treatment of Advanced Heart Failure

Abstract

Improved medical therapy is enabling a growing number of patients to survive previously fatal cardiovascular conditions, but many of these patients later succumb to advanced heart failure. Cardiac transplantation is an established surgical treatment option for advanced heart failure, but despite expansion of the criteria for donor selection, the number of hearts available for transplantation remains limited. Mechanical circulatory support with left ventricular assist devices is being used both as a bridge to transplantation and as destination therapy, and it may promote recovery of cardiac function in patients with advanced heart failure. Attempts to develop a transcutaneously powered total artificial heart are ongoing. Other treatments under investigation include surgical restoration of the left ventricular wall (Dor procedure) and passive left ventricular reshaping to reverse ventricular dilation, thereby preventing further myocardial cell death, and allowing hypertrophied cardiac cells to resume normal function. Mitral valve repair or replacement for severe secondary mitral regurgitation might also be useful in treating advanced heart failure. In contrast, partial left ventriculectomy is not recommended.