Non-transplant surgical management of end-stage heart failure

Despite a variety of available medical therapies and electrophysiological interventions, many heart failure patients still have a poor quality of life and a poor prognosis. Cardiac transplantation is currently the main treatment for end-stage heart failure in Taiwan but it is sometimes accompanied by rejection, immune compromise, and the adverse side effects of antirejection drugs. In addition, there is a shortage of donor grafts worldwide. For these reasons, other surgical interventions that alleviate ischemia and valvular dysfunction, and also reverse ventricular remodeling, should be considered before transplantation is advised. In this review, we discuss current nontransplant surgical management strategies for end-stage heart failure in terms of coronary revascularization, mitral reconstruction, ventricular reconstruction, and stem-cell regeneration of the myocardium. Copyright (C) 2012, Taiwan Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.