The Role of Cardiac Surgery

The role of cardiac surgery in the management of heart failure, is limited to

1. The correction of mechanical defects in the heart e.g. valvular heart disease, congenital heart disease,
   
2. Ischemic heart disease with clear evidence of reversible myocardial ischemia.
   
3. Cardiac transplantation.
   

For patients with dilated cardiomyopathy (ischemic or non-ischemic ), several types of novel cardiac surgery have been tried, in view of the shortage of donor hearts. Cardiac myoplasty, cardiac resection and heterozygous cardiac transplants have all been tried but with limited success, except in very select groups.

Left ventricular assist devices have been used to increase cardiac output and has often been used as a bridge-to-transplantation. Take for example this fascinating device known as the Tandem Heart.

Angioplasty has helped only in the population with ischemic heart disease and evidence of reversible myocardial ischemia.The mainstay of management of heart failure is still very much prevention (prevention of hypertension, diabetes, and coronary artery disease), and medical therapy, including lifestyle modification. Medical therapy of heart failure has improved tremendously, with the advent of drugs that not only improve symptoms but also prolong life.

Sometime in future a full article on management of heart failure will follow.