Advances in the surgical treatment of heart failure.
OBJECTIVE
Despite advancements in medical therapy, morbidity and mortality remain high. Surgical treatment of heart failure has been the subject of renewed focus, with a particular emphasis on applying the principles of evidence-based medicine to the evaluation of surgical therapies. The purpose of this review is to discuss emerging surgical therapies in heart failure, in particular, mechanical cardiac support and mitral valve repair.


RESULTS
The most widely established surgical therapy for heart failure is cardiac transplantation, but its impact is limited due to the limited number of donors. The Surgical Treatment for Ischemic Heart Failure study, a landmark evaluation of the role of coronary artery bypass grafting and surgical ventricular restoration in patients with ischemic heart disease and heart failure, has recently completed enrollment. Improvements in device design and patient selection appear likely to continue to improve outcomes with mechanical cardiac support in patients who are not deemed transplant candidates (destination therapy). Surgical repair of secondary mitral regurgitation is undergoing evaluation in the soon to be launched Surgery vs. Medical Treatment Alone for Patients with Mitral Regurgitation and Nonischemic study.


CONCLUSIONS
A variety of surgical therapies for heart failure are currently undergoing evaluation in randomized controlled trials. Data from these landmark studies will guide the application of surgical therapy in heart failure for the foreseeable future.
Allen
Larry A
LA
Division of Cardiovascular Medicine, Duke University Medical Center, Durham, North Carolina, USA.
Felker
G Michael
GM
D006348:Cardiac Surgical Procedures / Q000639:trends; D001026:Coronary Artery Bypass; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*