Surgical issues in heart failure: what's new?
Despite major advances in inotropic medications and our understanding of their proper use, surgical management of heart failure is the fastest-growing aspect of cardiovascular surgery. In addition to causing 750,000 deaths annually, myocardial infarctions leave an estimated 60,000 more patients in severe congestive heart failure and several times more individuals with compromised ventricular function. As these patients are offered reparative surgical options, surgeons, anesthesiologists, and cardiologists face physiologic challenges that can be optimally overcome only by modifying treatment strategies to address patients who have failed appropriate medical therapy, including milrinone, vasopressin, and nitric oxide. As our comfort with mechanical support increases, the threshold for embarking on these lines of treatment will be altered. Innovative devices have been created to meet this clinical need, but they must provide adequate quality of life to create sustainable value and health for society.
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Department of Medicine, Columbia-Presbyterian Medical Center, 117 Fort Washington Ave, New York, NY 10032, USA.
D000280:Administration, Inhalation; D006348:Cardiac Surgical Procedures / Q000295:instrumentation; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006333:Heart Failure / Q000188:drug therapy / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D009569:Nitric Oxide / Q000627:therapeutic use; D012196:Review Literature as Topic
D002316:Cardiotonic Agents; D009569:Nitric Oxide