الفهرس 
CARDIOMYOPATHYOnly 14 pages are availabe for public view
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Abstract
As surgical therapies for heart failure rapidly evolve, the need for their critical appraisal is essential so that they may be offered to the growing population of CHF patients in a prompt yet effective manner.
Transplantation continues to offer selected patients reliable long-term survival in a reproducible fashion, and it thus remains as a gold standard surgical therapy for heart failure.
Though in time we may see mechanical assist devices play a more prevalent role in myocardial recovery or destination therapy, currently their main utility is as a bridge to transplantation.
With the growing disparity between donor availability and heart failure patients, experience is mounting with effective nontransplant surgical solutions.
The results of the more conventional techniques of CABG, geometric mitral reconstruction, and ventricular reconstruction when combined with the optimal medical management of heart failure may now be on a par with transplantation. Therefore, these modalities now form the new first-line surgical therapy for heart failure when applicable.
Patients with primary ischemic cardiomyopathy with favorable anatomy may be effectively managed with revascularization alone or in combination with LV reconstruction. Myopathic patients with MR, regardless of etiology, may be effectively managed with mitral reconstruction. With the superior results of these approaches, the use of other techniques such as Partial left ventriculectomy (PLV) and Dynamic cardiomyoplasty (DCMP) should be reserved as viable alternative surgical options for heart failure.
Ventricular restoration by left ventriculoplasty has evolved as proposed by Dor et al to treat ischemic cardiomyopathy and by Batista et al to treat mostly nonischemic cardiomyopathy, the septal anterior ventricular exclusion (SAVE) procedure with mitral reconstruction is a useful option for the treatment of advanced idiopathic dilated cardiomyopathy in extremely dilated left ventricle with akinetic septum.
Thus at this time, when similar if not superior results can be obtained by methods that preserve myocardial integrity, the application of PLV to patients with end-stage heart failure should be approached with an element of caution.
The prudent and effective application of the growing menu of surgical strategies for heart failure enables the scarcely available donor hearts be efficiently used for patients with truly no other surgical or medical alternatives.
Along with the utility of emerging biomedical devices, each of these unique modalities has enhanced the clinically effective armamentarium of the modern surgeon treating patients with heart failure.