Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Surgical management of heart failure

James C Fang, MD
Section Editors
Wilson S Colucci, MD
Gabriel S Aldea, MD
Edward Verrier, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


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" 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 "Diagnosis and management of ischemic cardiomyopathy".)

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".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Sep 10, 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Klein P, Braun J, Holman ER, et al. Management of mitral regurgitation during left ventricular reconstruction for ischemic heart failure. Eur J Cardiothorac Surg 2012; 41:74.
  2. Qin JX, Shiota T, McCarthy PM, et al. Importance of mitral valve repair associated with left ventricular reconstruction for patients with ischemic cardiomyopathy: a real-time three-dimensional echocardiographic study. Circulation 2003; 108 Suppl 1:II241.
  3. Tulner SA, Steendijk P, Klautz RJ, et al. Clinical efficacy of surgical heart failure therapy by ventricular restoration and restrictive mitral annuloplasty. J Card Fail 2007; 13:178.
  4. Acker MA, Bolling S, Shemin R, et al. Mitral valve surgery in heart failure: insights from the Acorn Clinical Trial. J Thorac Cardiovasc Surg 2006; 132:568.
  5. Acker MA, Jessup M, Bolling SF, et al. Mitral valve repair in heart failure: five-year follow-up from the mitral valve replacement stratum of the Acorn randomized trial. J Thorac Cardiovasc Surg 2011; 142:569.
  6. Batista RJ, Santos JL, Takeshita N, et al. Partial left ventriculectomy to improve left ventricular function in end-stage heart disease. J Card Surg 1996; 11:96.
  7. Popović Z, Mirić M, Gradinac S, et al. Effects of partial left ventriculectomy on left ventricular performance in patients with nonischemic dilated cardiomyopathy. J Am Coll Cardiol 1998; 32:1801.
  8. Etoch SW, Koenig SC, Laureano MA, et al. Results after partial left ventriculectomy versus heart transplantation for idiopathic cardiomyopathy. J Thorac Cardiovasc Surg 1999; 117:952.
  9. Schenk S, McCarthy PM, Starling RC, et al. Neurohormonal response to left ventricular reconstruction surgery in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2004; 128:38.
  10. Jones RH, Velazquez EJ, Michler RE, et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N Engl J Med 2009; 360:1705.
  11. Dor V, Civaia F, Alexandrescu C, et al. Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. J Thorac Cardiovasc Surg 2011; 141:905.
  12. https://www.clinicaltrials.gov/ct2/show/NCT01286116 (Accessed on September 08, 2015).
  13. Mazzaferri EL Jr, Gradinac S, Sagic D, et al. Percutaneous left ventricular partitioning in patients with chronic heart failure and a prior anterior myocardial infarction: Results of the PercutAneous Ventricular RestorAtion in Chronic Heart failUre PaTiEnts Trial. Am Heart J 2012; 163:812.
  14. Mann DL, Acker MA, Jessup M, et al. Clinical evaluation of the CorCap Cardiac Support Device in patients with dilated cardiomyopathy. Ann Thorac Surg 2007; 84:1226.
  15. Starling RC, Jessup M, Oh JK, et al. Sustained benefits of the CorCap Cardiac Support Device on left ventricular remodeling: three year follow-up results from the Acorn clinical trial. Ann Thorac Surg 2007; 84:1236.
  16. Mann DL, Kubo SH, Sabbah HN, et al. Beneficial effects of the CorCap cardiac support device: five-year results from the Acorn Trial. J Thorac Cardiovasc Surg 2012; 143:1036.
  17. Abraham WT. Ventricular elastic support therapy (VEST) in stage C heart failure: Analysis from the PEERLESS-HF study. Heart Failure Society of America 2010 Scientific Meeting; September 13, 2010.; San Diego, CA. Late-breaking clinical trial 1.
  18. Schreuder JJ, Steendijk P, van der Veen FH, et al. Acute and short-term effects of partial left ventriculectomy in dilated cardiomyopathy: assessment by pressure-volume loops. J Am Coll Cardiol 2000; 36:2104.
  19. Batista RJ, Verde J, Nery P, et al. Partial left ventriculectomy to treat end-stage heart disease. Ann Thorac Surg 1997; 64:634.
  20. Angelini GD, Pryn S, Mehta D, et al. Left-ventricular-volume reduction for end-stage heart failure. Lancet 1997; 350:489.
  21. Franco-Cereceda A, McCarthy PM, Blackstone EH, et al. Partial left ventriculectomy for dilated cardiomyopathy: is this an alternative to transplantation? J Thorac Cardiovasc Surg 2001; 121:879.
  22. Moreira LF, Stolf NA, Bocchi EA, et al. Partial left ventriculectomy with mitral valve preservation in the treatment of patients with dilated cardiomyopathy. J Thorac Cardiovasc Surg 1998; 115:800.
  23. Bestetti RB, Moreira-Neto F, Brasil JC, et al. Partial left ventriculectomy: preoperative risk factors for perioperative mortality. Int J Cardiol 1998; 67:143.
  24. Gradinac S, Mirić M, Popović Z, et al. Partial left ventriculectomy for idiopathic dilated cardiomyopathy: early results and six-month follow-up. Ann Thorac Surg 1998; 66:1963.
  25. Stolf NA, Moreira LF, Bocchi EA, et al. Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy. Ann Thorac Surg 1998; 66:1585.
  26. Starling RC, McCarthy PM, Buda T, et al. Results of partial left ventriculectomy for dilated cardiomyopathy: hemodynamic, clinical and echocardiographic observations. J Am Coll Cardiol 2000; 36:2098.
  27. Kass DA, Baughman KL, Pak PH, et al. Reverse remodeling from cardiomyoplasty in human heart failure. External constraint versus active assist. Circulation 1995; 91:2314.
  28. Acker MA. Dynamic cardiomyoplasty: at the crossroads. Ann Thorac Surg 1999; 68:750.
  29. Leier CV. Cardiomyoplasty: is it time to wrap it up? J Am Coll Cardiol 1996; 28:1181.