The role of surgery (non-transplant) in the treatment of severe congestive heart failure.
Advanced heart failure has been considered the main indication for heart transplantation, but the increasing numbers of candidates and shortage of organs for transplantation, with growing waiting lists, has prompted another look at more conventional surgery, previously considered of prohibitive risk. In fact, many cases are the result of anatomical lesions which can be corrected by conventional surgery, and in the past decade many surgical groups have obtained good and even excellent results in the treatment of aortic stenosis with low output and in aortic and mitral regurgitation with severe LV dysfunction. Also, ischemic and idiopathic dilated cardiomyopathy have been successfully treated by several types of LV remodeling surgery, with or without coronary grafting. Many of these procedures have achieved excellent operative and medium- and long-term results and survival which compare favorably with those observed with cardiac transplantation, often with advantages in quality of life and, not unimportantly, in financial costs. For operated patients, especially those with ischemic cardiomyopathy, close follow-up for cardiac failure is extremely important in order to determine the right moment for heart transplantation, if it becomes necessary.
de Oliveira
J Ferrão
JF
Centro de Cirurgia Cardiotorácica, Hospital da Universidade de Coimbra, Coimbra, Portugal.
Antunes
Manuel J
MJ
D006348:Cardiac Surgical Procedures / Q000379:methods; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000601:surgery; D006333:Heart Failure / Q000209:etiology / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications / Q000601:surgery; D012720:Severity of Illness Index