Non-transplant surgery of heart failure

Congestive heart failure is a major public health problem in western countries. Although substantial efforts have been made in the last decades in the prevention, diagnosis and treatment of cardiovascular disease, the incidence of end-stage dilated cardiomyopathy is still increasing. Heart transplantation represents the most effective therapy in this setting, but due to shortage of donors, it remains a realistic option just for a very small number of patients. Therefore, conventional surgical treatment for end-stage heart disease has gained increasing attention in recent years and a variety of surgical interventions have been improved or optimized to manage the multifactorial pathophysiology of the heart failure picture. The aim of this review is to report our experience with more than 500 patients with advanced dilated cardiomyopathy, treated with conventional surgical procedures such as myocardial revascularization, left ventricular restoration, mitral valve repair and surgical ablation of atrial fibrillation. Indications, results, controversial issues and future perspectives will be discussed.