Role of surgery in the treatment of severe congestive heart failure]

Patients with severe congestive heart failure which is not reversible by therapy and caused by mechanical abnormalities that are not surgically correctable, generally constitute desperate cases in which surgical intervention is only palliative. Currently, only transplantation can be considered an adequate mid-term therapy, while cardiomyoplasty and ventricular reduction (Batista) have not evolved as viable alternatives. The former has not yielded satisfactory results and the experience with the latter is still too short, although the short term results also appear discouraging. The shortage of available organs for the number of patients on the waiting list and the rejection and infection phenomena, which remain the main difficulties with transplantation, may be overcome in the not too distant future. Finally, the artificial heart will almost certainly be an alternative, but it may, eventually, be overthrown by xenotransplantation.