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Review
. 2008 May;23(3):249-53.
doi: 10.1097/HCO.0b013e3282f54fea.

Advances in the surgical treatment of heart failure

Larry A Allen  1 , G Michael Felker
Affiliations
Review

Advances in the surgical treatment of heart failure

Larry A Allen et al. Curr Opin Cardiol. 2008 May.

Abstract

Purpose of review: 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.

Recent findings: 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.

Summary: 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.

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Figures

Figure 1
Figure 1. Design of the Surgical Treatment for Ischemic Heart Failure (STICH) study
CABG, coronary artery bypass grafting; CAD, coronary artery disease; EF, ejection fraction; MED, medical therapy; SVR, surgical ventricular restoration. (Data from Velazquez et al. [4••].)
Figure 2
Figure 2. Change in ejection fraction over time after mitral valve repair in patients enrolled in the Acorn Clinical Trial
Data from Acker et al. [30••].
See this image and copyright information in PMC

References

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