title: Surgical approach to end-stage heart failure.
abstract: OBJECTIVE
  End-stage heart failure is a challenging disease with growing incidence. With decreasing heart transplant rates worldwide organ preserving therapies become, again, of interest. The purpose of the present review is to examine the potential challenges of surgical therapies in patients with end-stage heart failure.
  
  
  RESULTS
  The gold-standard for end-stage heart failure is and will be cardiac transplantation. However, due to organ shortage this therapy is limited to a few patients. Therefore implantation of ventricular assist devices (VADs) or long-term minimal-invasive partial support devices will increase. Improvements in device design with smaller devices, easier implantation techniques, and modified anticoagulation outcome and long-term success will likely improve. In addition, good quality of life as destination therapy is almost available. Organ conservation surgery (coronary artery bypass grafting and surgical ventricular restoration or surgical repair of mitral valve regurgitation) in end-stage heart failure patients could not prove the expected results. Transcatheter or minimal-invasive approaches of these therapies might become routine in the near future.
  
  
  CONCLUSIONS
  Due to the overwhelming outcome rates, cardiac transplantation is the most established surgical therapy for end-stage heart failure. VAD therapy is increasing and minimized VADs might further open the market for destination therapy/permanent support.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital Muenster, Muenster, Germany. stefan.klotz@ukmuenster.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Klotz
authors.forename: Hans H
authors.initials: HH
authors.lastname: Scheld
mesh_terms: D001026:Coronary Artery Bypass; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008943:Mitral Valve / Q000601:surgery