[Surgical treatment of patients with congestive heart failure]

Surgical intervention is a treatment of choice in chronic congestive heart failure from long standing myocardial ischemia or old myocardial infarction. Right sided heart failure is a higher risk factor for surgery than a left sided one. Hemodynamic instability following acute myocardial ischemia in spite of medical treatment is an indication for urgent surgery. Hemodynamic deterioration from acute valvular lesions, such as infectious endocarditis, malfunction of the prosthetic valve, and trauma, are also indications for urgent surgery. Although surgical results are correlated with NYHA classification, chronic right sided heart failure increases the morbidity. Dynamic cardiomyoplasty is a new treatment for otherwise uncorrectable congestive heart failure. Multicenter trial reported 40% of mortality and an average improvement of NYHA class from 3.5 to 2.1.