Related Experiment Videos
Surgical therapy in advanced heart failure
Ettore Vitali1, Tiziano Colombo, Pasquale Fratto
1Department of Cardiothoracic Surgery, A. De Gasperis Heart Center, Cà Granda Niguarda Hospital, Milan, Italy. ettorevitali@tin.it
Insights
Surgical treatments for congestive heart failure (CHF) have advanced, offering alternatives to heart transplantation due to donor organ shortages. These options include ventricular assist devices and reconstructive surgeries for end-stage heart disease.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Technology
Background:
- Congestive heart failure (CHF) impacts 1% of US adults, causing over 250,000 deaths annually.
- The aging population drives increased demand for CHF treatments, straining healthcare resources.
- Heart transplantation offers a 10-year survival rate near 50% but faces donor organ scarcity.
Purpose of the Study:
- To review the evolution and current status of surgical interventions for end-stage heart disease.
- To discuss alternatives to cardiac allotransplantation for managing congestive heart failure.
- To present personal experiences and insights into surgical treatment of advanced heart failure.
Main Methods:
- Review of historical and current surgical procedures for end-stage heart disease.
- Discussion of left ventricular assist devices (LVADs) as bridge-to-transplant, recovery, or destination therapy.
- Examination of alternative surgical options like ventricular reconstruction (Batista, Dor), mitral valve repair, cardiomyoplasty, and advanced CABG.
Main Results:
- Surgical treatment for CHF has significantly progressed over three decades.
- Left ventricular assist devices are increasingly utilized for various therapeutic goals.
- Various reconstructive and reparative surgeries are emerging as viable alternatives to transplantation.
Conclusions:
- The shortage of donor organs necessitates the development and application of alternative surgical strategies for CHF.
- Advancements in device therapy and surgical reconstruction offer new hope for patients with end-stage heart failure.
- Continued innovation in surgical techniques is crucial for improving outcomes in congestive heart failure management.
Abstract:
Congestive heart failure (CHF) affects about 1% of adults in the United States and is a contributing factor in >250,000 deaths per year. In an increasingly elderly population, the surgical treatment of CHF made great progress during the past 3 decades, consuming enormous health care resources. Heart transplantation is still the most effective therapy for end-stage heart disease, with the 10-year survival rate after transplantation approaching 50%. Efforts to increase the supply of donor organs have failed to improve the shortage, underscoring the crucial need for alternatives to cardiac allotransplantation. Alternative surgical options to end-stage heart transplantation are rapidly evolving. Left ventricular assist devices have been used as a bridge to heart transplantation for patients who otherwise might die awaiting a new heart. There is also continued interest in the use of these devices either to bridge patients to full recovery or to destination therapy, without the need for heart replacement. Left ventricular reconstruction, including the Batista and Dor procedures, along with mitral valve repair, cardiomyoplasty, and extreme coronary artery bypass graft surgery, are now being increasingly performed as alternative options. The history, status, and personal experience of surgical treatment of end-stage heart disease are discussed.