TY - JOUR
T1 - Surgical Treatment of Advanced Heart Failure
T2 - Alternatives to Heart Transplantation and Mechanical Circulatory Assist Devices
AU - George, Timothy J.
AU - Arnaoutakis, George J.
AU - Shah, Ashish S.
PY - 2011/9
Y1 - 2011/9
N2 - Although orthotopic heart transplantation is the gold standard for definitive surgical treatment of end-stage heart failure, other operative therapies exist for dealing with severe systolic left ventricular dysfunction. The choice of surgical intervention depends on the etiology and functional characteristics of the patient's ventricular dysfunction. In patients with ischemic cardiomyopathy, surgical revascularization improves survival. Patients with mitral regurgitation experience significant functional improvement from mitral valve repair and replacement. In patients with aortic valve dysfunction, aortic valve replacement results in improved survival and functional status. Although surgical ventricular reconstruction is controversial, significant data exist suggesting that it is an effective therapy in a subset of patients with left ventricular dysfunction. Finally, passive restraint devices are effective at halting further ventricular dilation. Although cardiac surgery in patients with severe ventricular dysfunction can be complicated by significant morbidity and mortality, experienced centers have demonstrated acceptable outcomes in carefully selected patients.
AB - Although orthotopic heart transplantation is the gold standard for definitive surgical treatment of end-stage heart failure, other operative therapies exist for dealing with severe systolic left ventricular dysfunction. The choice of surgical intervention depends on the etiology and functional characteristics of the patient's ventricular dysfunction. In patients with ischemic cardiomyopathy, surgical revascularization improves survival. Patients with mitral regurgitation experience significant functional improvement from mitral valve repair and replacement. In patients with aortic valve dysfunction, aortic valve replacement results in improved survival and functional status. Although surgical ventricular reconstruction is controversial, significant data exist suggesting that it is an effective therapy in a subset of patients with left ventricular dysfunction. Finally, passive restraint devices are effective at halting further ventricular dilation. Although cardiac surgery in patients with severe ventricular dysfunction can be complicated by significant morbidity and mortality, experienced centers have demonstrated acceptable outcomes in carefully selected patients.
KW - Heart failure
KW - Surgery
KW - Ventricular dysfunction
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U2 - 10.1016/j.pcad.2011.04.001
DO - 10.1016/j.pcad.2011.04.001
M3 - Article
C2 - 21875511
AN - SCOPUS:80052186372
SN - 0033-0620
VL - 54
SP - 115
EP - 131
JO - Progress in Cardiovascular Diseases
JF - Progress in Cardiovascular Diseases
IS - 2
ER -