[Surgery in advanced heart failure].

BACKGROUND

ACE inhibitors and beta blockers have reduced morbidity and mortality from chronic heart failure significantly during the last years. Apart from medical therapy several surgical strategies for the treatment of heart failure are available.

PREREQUISITES OF SURGICAL TREATMENT: Surgical treatment should be directed towards the underlying etiology and mechanisms. To decide for a special surgical therapy indications and contraindications must be considered.

SURGICAL PROCEDURES: The surgical therapy of heart failure can be performed with or without replacement of the heart. Especially concerning the organ-conserving techniques there has been significant progress during the last years: left ventricular aneurysmectomy, mitral valve surgery as well as high-risk coronary artery bypass surgery and electrostimulating procedures. Concerning heart replacement therapy, cardiac transplantation with a 10-year survival of 50% still remains superior to all available mechanical devices at the moment.