[Surgery of heart insufficiency]

Area of Science:

• Cardiovascular Surgery
• Heart Failure Management
• Surgical Techniques

Context:

• Heart transplantation is a primary treatment for heart failure, but surgical alternatives are crucial.
• Ischemic heart disease and enlarged heart disease present distinct surgical challenges.
• Patient selection criteria are vital for successful surgical interventions.

Purpose:

• To review and assess surgical approaches for heart failure beyond transplantation.
• To evaluate the efficacy and indications for coronary bypass, Dor procedure, and mitral plasty.
• To compare outcomes and limitations of various surgical techniques for heart failure.

Summary:

• Coronary bypass requires adequate myocardial reserve and absence of severe pulmonary hypertension.
• The Dor procedure reshapes the left ventricle, improving function in dyskinetic or akinetic cases.
• Mitral plasty techniques, including annuloplasty and specific procedures like Bolling's, address mitral failure.
• The Batista procedure reduces left ventricular size in severe cases, often combined with mitral plasty.

Impact:

• Surgical interventions demonstrate encouraging improvements in functional class and left ventricular function.
• These techniques provide viable alternatives to heart transplantation for select patients.
• Further research is needed to compare surgical outcomes with medical management and to refine advanced techniques.