Surgical management of heart failure

Surgical therapy for congestive heart failure can offer gratifying results in selected elderly patients. Several trials have shown a survival advantag e for surgical revascularization compared with medical therapy in the treat ment of ischemic cardiomyopathy. Aortic valve replacement is highly effecti ve in treating elderly patients with heart failure caused by severe aortic stenosis, and stentless aortic valves seem to provide a survival advantage in elderly patients with low-gradient aortic stenosis. Mitral valve repair with or without coronary revascularization has been used successfully in pa tients with severe mitral regurgitation. Transplantation is a viable but ra rely used option for elderly patients with congestive heart failure. Totall y implantable ventricular assist devices are an exciting new option for eld erly patients with congestive heart failure who are not heart transplantati on candidates.