Non-transplant surgical therapy options of heart failure

Congestive heart failure (CHF) results from damage to the myocardium and has a broad etiology ranging from ischemic to non--ischemic etiology. It is one of the leading causes of cardiovascular morbidity and mortality and carries a 5--year mortality of 50%, estimated by WHO to represent 30% of deaths in the United States. Costs related to the care of patients with CHF have increased substantially over the past 2 decades partly owing to increased frequency of hospitalization, implantation of costly novel devices and, as the disease progresses, consideration for heart transplantation, mechanical circulatory support, and end--of--life care. CHF progression is accompanied by changes within the myocardium, collectively referred to as left ventricular remodeling, which can be categorized into changes in the cardiomyocytes and changes that occur in the volume and composition of the extracellular matrix. Since remodeling in heart failure is progressive and detrimental, the majority of treatment strategies are aimed at stopping or possibly reversing this process. Some successful methods include medical management, long--term or destination mechanical circulatory support, cardiac resychronization therapy, and biventricular pacemakers. During the last few decades, the management of heart failure has evolved tremendously with the introduction of new therapies and assist devices. Advances in mechanical support, left ventricular assist devices (LVADs), and total artificial heart have significantly reduced mortality in patients awaiting transplantation. This manuscript is an overview of non--transplant surgical options in the management of CHF.