Far out, but interesting
2-17 SURGICAL MANAGEMENT OF HEART FAILURE
The natural course of heart failure (HF) is progressive. Even with the use of angiotension converting enzyme inhibitors, the only medical treatment to have consistently improved prognosis, the annual mortality is 25%-50%.
A few patients with HF may benefit from revascularization, albeit at a higher operative risk. Valvular disease may merit repair or replacement. For many, the only surgical option is transplantation.
Newer surgical approaches include cardiomyoplasty, left ventricular volume reduction, and mechanical support.
Cardiomyoplasty is the transposition of skeletal muscle (most commonly latissmus dorsi) which is elevated and transposed through the chest wall to be wrapped around the heart to provide systolic or diastolic augmentation to the native heart. Operative and one year mortality is high.
Implantable left ventricular assist devices augment the function of the native heart. Their success in supporting patients awaiting transplantation (bridge to transplantation) has encouraged their permanent implantation.
Left ventricular volume reduction has been promoted for dilated cardiomyopathy by the Brazilian surgeon Batista. A large section of ventricular muscle is resected. This results in a reduction in the radius and an increase in wall thickness of the left ventricle. Results have been sufficiently compelling for several American and European centers to embark on pilot trials.

BMJ February 15, 1997; 314: 453-54 Editorial from Oxford Radcliffe Hospital, Oxford, UK

Comment:
Not a practical point at this time. I abstracted the article because of its general interest. RTJ

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