[Present and future options for the surgical treatment of patients with advanced heart failure].
Despite considerable improvement in the medical treatment of heart failure, cardiac transplantation remains the gold standard for the treatment of end-stage patients. However, organ shortage forces to look for alternative therapies. A number of innovative approaches are being investigated in terms of improved survival and quality of life in patients refractory to medical therapy. The main cause of heart failure is represented by ischemic cardiomyopathy, responsible for up to 65% of its prevalence in the population. Long-term survival of patients affected by advanced heart failure due to ischemic cardiomyopathy is still unsatisfactory, in spite of improved medical therapy. Besides heart transplantation and the implantation of ventricular assist devices, a surgical option is represented by conventional heart surgery, consisting of myocardial revascularization associated with surgical ventricular restoration, correction of mitral valve regurgitation, and cardiac resynchronization therapy. The STICH trial (Surgical Treatment for Ischemic Heart Failure), an international multicenter trial sponsored by the US National Heart Lung and Blood Institute, will provide important information regarding the effectiveness of such surgical treatment. A new therapeutic option could be represented in the next future by the clinical use of intracardiac elastic devices, currently under investigation, which can be implanted at the mitral annulus and at the level of the left ventricular equator.
Ferrazzi
Paolo
P
Dipartimento Cardiovascolare Clinico e di Ricerca, Ospedali Riuniti, Bergamo. pferrazzi@ospedaliriuniti.bergamo.it
Triggiani
Michele
M
Simon
Caterina
C
Iacovoni
Attilio
A
Pentiricci
Samuele
S
Senni
Michele
M
Quaini
Eugenio
E
Gavazzi
Antonello
A
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures; D009202:Cardiomyopathies / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006333:Heart Failure / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000601:surgery; D006353:Heart-Assist Devices; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery; D015337:Multicenter Studies as Topic; D017202:Myocardial Ischemia / Q000601:surgery*; D009204:Myocardial Revascularization; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures; D013997:Time Factors