Surgical issues in heart failure: What's new?

Despite major advances in inotropic medications and our understanding of th eir proper use, surgical management of heart failure is the fastest-g owing aspect of cardiovascular surgery. In addition to causing 750,000 deaths an nually, myocardial infarctions leave an estimated 60,000 more patients in s evere congestive heart failure and several times more individuals with comp romised ventricular function. As these patients are offered reparative surg ical options, surgeons, anesthesiologists, and cardiologists face physiolog ic challenges that can be optimally overcome only by modifying treatment st rategies to address patients who have failed appropriate medical therapy, i ncluding milrinone, vasopressin, and nitric oxide. As our comfort with mech anical support increases, the threshold for embarking on these lines of tre atment will be altered. Innovative devices have been created to meet this c linical need, but they must provide adequate quality of life to create sust ainable value and health for society.