Surgical management of heart failure
- James C Fang, MD
James C Fang, MD
- Professor of Medicine
- University of Utah
- Section Editors
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
- Gabriel S Aldea, MD
Gabriel S Aldea, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington
- Edward Verrier, MD
Edward Verrier, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington School of Medicine
Progress in the medical therapy of patients with heart failure (HF) has led to current treatment recommendations for use of beta blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), diuretics, and aldosterone antagonists. In addition, cardiac resynchronization therapy and implantable defibrillators are also recommended for selected patients. (See "Overview of the therapy of heart failure with reduced ejection fraction".)
Options for surgical management of patients with end-stage, refractory systolic HF are more limited. Heart transplantation remains the ultimate treatment for end-stage HF, but the persistent shortage of donor hearts, contraindications due to recipient comorbidities, and transplant complications limit the utility of this approach. Thus, heart transplantation is not an option for most patients with end-stage HF. (See "Indications and contraindications for cardiac transplantation in adults" and "Prognosis after cardiac transplantation".)
Other surgical approaches to end-stage HF continue to evolve. Although large randomized trials are unusual in this field, important steps have been made over the past 10 to 15 years, as discussed below. However, the use of any of these approaches remains highly individualized. Current strategies include:
●Coronary revascularization in selected patients with ischemic cardiomyopathy and hibernating myocardium. (See "Ischemic cardiomyopathy: Treatment and prognosis".)
●Left ventricular assist devices (LVADs) as a bridge to heart transplantation or as permanent circulatory assistance, also referred to as destination therapy (figure 1). The use of these devices is discussed elsewhere. (See "Intermediate- and long-term mechanical circulatory support" and "Practical management of long-term mechanical circulatory support devices".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CORONARY REVASCULARIZATION
- MANAGEMENT OF CHRONIC SECONDARY MITRAL REGURGITATION
- LEFT VENTRICULAR RECONSTRUCTION
- STICH trial
- Role of ventricular reconstruction following STICH trial
- MECHANICAL INHIBITION OF DILATION
- LARGELY ABANDONED PROCEDURES
- Batista procedure
- SUMMARY AND RECOMMENDATIONS