Nontransplant surgical treatment for advanced heart failure

Purpose of review The treatment for advanced heart failure is a challenge. Heart failure presents with a wide spectrum of disease severity, and with a broad risk of associated morbidity and mortality. Heart transplantation has been the one and only effective option for end-stage heart failure. Several nontransplant surgeries have, however, been developed and this article reviews these novel approaches. Recent findings Surgical left ventricular restoration for ischemic cardiomyopathy significantly improved cardiac function and long-term survival. Ongoing prospective studies may provide more accurate strategies. The surgical strategy for idiopathic dilated cardiomyopathy is still controversial. Undersized ring annuloplasty for functional mitral regurgitation has no effect on survival, but novel annular and subvalvular techniques may prevent failure. Cardiac resynchronization therapy concomitant with surgical ventricular restoration may further improve cardiac performance. With the aid of new ablation devices, surgery for atrial fibrillation has become a safe and surgeon-friendly procedure. The combination of surgery with regenerative medicine may bring additional benefits to the problematic therapy in the next few years. Summary A combination of surgical procedures is required to address the multiple pathophysiologic components of advanced heart failure; however, optimal indications and operations are still under investigation. Data from ongoing prospective randomized trails are awaited.