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Surgical Treatments for Endstage Heart Failure Due to Dilated Cardiomyopathy

Department of Thoracic and Cardiovascular Surgery Heart Center North-Rhine-Westphalia Bad Oeynhausen Ruhr-University of Bochum Bad Oeynhausen, Germany

Prognosis of endstage heart failure, categorized as class III or IV on the New York Heart Association (NYHA) classification, remains extremely poor despite advances in drug therapy, such as angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and nitric oxide (NO). Of the 100,000 patients in Germany and 400,000 patients in the USA reported as suffering from drug-resistant endstage heart failure, 500 and 370 German patients and 2,500 and 700 American patients undergo heart transplantation and ventricular assist device (VAD) implantation, respectively, every year. Transplantation has been considered the gold standard for treating endstage heart failure until recently. Although the outcome of heart transplantation has improved with advances in immunosuppressants, less than 10% of patients awaiting transplant can actually have a transplant because of a shortage in donor organs.^1,2 Consequently, various alternative surgical procedures have been actively performed in recent years to treat drug-resistant endstage heart failure. These include myocardial revascularization for borderline indication due to severe left ventricular dysfunction; volume reduction ventriculectomy such as Batista operation and Dor procedure; implantation of various assisted circulation systems such as intraaortic balloon pump (IABP), percutaneous cardiopulmonary support (PCPS), cardiomyoplasty, extracorporeal membrane oxygenation (ECMO), and ventricular assist device (VAD); orthotopic heart transplantation (HTx); and biventricular pacing.

These alternative treatments are now used even for cases that previously would have undergone transplantation, and cardiac function can be improved in some heart failure patients without transplantation. Thus, the selection of an adequate treatment method is now considered necessary from an economic point of view, as well as from a medical point of view.

In this article, we report on the effectiveness, problems, and further prospects of various surgical treatments for drug-resistant endstage heart failure, based on our experience.

Borderline Indication for Myocardial Revascularization

Myocardial revascularization for severe left ventricular dysfunction, for which surgery had been considered unsuitable, had produced only poor postoperative outcomes . . . [Full Text of this Article]

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