Surgical options for the treatment of heart failure.

This article will examine the role of specific surgical interventions for congestive heart failure (CHF). The most definitive surgical option for severe end-stage heart failure is cardiac transplantation. In general, patients considered for heart transplant should have severe heart disease despite all other therapies with a high risk of death within 1 year. Noncardiac conditions that would by themselves shorten life expectancy or increase the risks of rejection, infection, or other fatal complication, should not be present. However, in light of the limited donor pool, complications associated with long-term immunosuppressive therapy, and the ever-increasing number of CHF patients, the role of cardiac transplantation for CHF will continue to be limited. The conduct of and evaluation for cardiac transplantation has been well described previously and therefore will not be evaluated in this review (1); however, there has been recent progress in the genetic modification of animal organs for potential use in transplantation (xenografts) (2). If these developments come to fruition, then cardiac transplantation/organ replacement may become a surgical option for a much greater number of CHF patients. One alternative approach to complete cardiac transplantation is the surgical placement of transformed cells into the diseased myocardium, briefly discussed under "Future Directions." This article will examine surgical options that are currently being used for CHF patients, surgical modalities that are currently under clinical evaluation, and finally, potential future therapies with respect to surgical options for heart failure.