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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 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".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 10, 2015.
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