Surgical Options for the Management of Congestive Heart Failure : Special Topic Issue: Cardiology 2004, Vol. 101, No. 1-3

Congestive heart failure (CHF) is one of the most common killers worldwide and is becoming more prevalent as the population continues to age. Despite great advances in medical drug treatment and the liberal use of pacemakers and internal defibrillators, the outcome of CHF remains poor, which has prompted investigators to consider new surgical options for its management. This special issue compiles contributions from a select group of investigators and experts from premier medical centers. It covers many important topics, including aortic valve replacement for valvular cardiomyopathy, mitral valve repair, myocardial revascularization in patients with ventricular dysfunction, the pros and cons of beating heart versus on-pump coronary artery bypass surgery (CABG), and clinical trials comparing CABG to percutaneous coronary interventions. The ongoing clinical trials in the surgical management of CHF, the experience with ventricular reduction and remodeling surgery as well as the current status of heart transplantation are reviewed. Consideration is also given to resynchronization therapy and biventricular pacing for CHF, and the use of ventricular assist devices as destination therapy and as a bridge to transplantation or recovery. The reader is updated on the clinical experience with the Jarvik 2000 ventricular assist device and the AbioCor total artificial heart. Further novel approaches discussed are gene therapy for premature coronary artery disease, therapeutic angiogenesis, transmyocardial laser revascularization and cardiac xenotransplantation. This publication will be of special interest to clinicians and investigators in cardiology and cardiac surgery, medical and surgical residents and fellows in training, and general practitioners. Contents......Page 4 Surgical Options for the Management of Congestive Heart Failure......Page 5 Reference......Page 6 Introduction......Page 7 Aortic Stenosis......Page 8 Aortic Regurgitation......Page 11 References......Page 13 Introduction......Page 15 Anatomic and Functional Alterations......Page 16 Surgical Options for Valve Repair or Replacement......Page 17 Clinical and Therapeutic Correlates......Page 18 Conclusion......Page 19 References......Page 20 Introduction......Page 21 The European Coronary Surgery Study......Page 22 The Arterial Revascularization Therapies Study......Page 23 The Argentine Randomized Study......Page 24 The Coronary Angioplasty versus Bypass Revascularization Investigation......Page 25 Recent Clinical Series in Patients with Ventricular Dysfunction......Page 26 Conclusions......Page 27 References......Page 28 Myocardial ‘Stunning ’and ‘Hibernation’......Page 29 Evaluation of Myocardial Viability......Page 30 On-Pump CABG in Patients with Depressed LV Function......Page 31 Benefits of Off-Pump Surgery......Page 32 Off-Pump CABG in Patients with a ‘Poor Ventricle’......Page 33 The Tufts-New England Medical Center Off-Pump CABG Experience......Page 34 References......Page 35 Clinical Results......Page 37 Operative Technique......Page 38 Angina Class......Page 39 Myocardial Perfusion......Page 40 Long-Term Results......Page 41 Mechanisms of TMR......Page 42 Angiogenesis......Page 43 Conclusion......Page 44 References......Page 45 Introduction......Page 48 Surgical Ventricular Restoration......Page 49 Phase One Human Trials of Autologous Skeletal Myoblast CCM......Page 54 Stem Cells and Beyond......Page 57 References......Page 58 Introduction......Page 61 LV Reconstruction for Ischemic Cardiomyopathy......Page 62 Partial Left Ventriculectomy......Page 66 Conclusion......Page 69 References......Page 70 Introduction......Page 72 Clinical Trials of Permanent Biventricular Pacing......Page 73 Heart Failure Severity......Page 74 Baseline Rhythm......Page 75 Implantation Techniques and Technical Issues......Page 76 Conclusions......Page 77 References......Page 78 Predictors of Compromised Survival in CHF......Page 79 Indications for Transplant Listing......Page 80 Demographics......Page 81 Donor Identification......Page 82 Organ Allocation......Page 83 Graft Procurement and Techniques of Transplantation......Page 84 Rejection Grading and Surveillance......Page 85 Induction and Maintenance......Page 86 Prevention of Graft Vasculopathy......Page 87 Management of Pulmonary Hypertension......Page 88 Noninfectious Complications......Page 89 Fungal and Protozoal Infections......Page 90 Conclusions......Page 91 References......Page 92 Introduction......Page 93 Novacor Left Ventricular Assist System......Page 94 CardioWest Total Artificial Heart......Page 95 LVAD Implantation in Younger and Older Patients......Page 96 Potential for Recovery of the Failing Myocardium......Page 97 Time Course of Cardiac Recovery......Page 98 Future Perspectives on Cardiac Recovery......Page 99 Jarvik 2000 Heart......Page 100 References......Page 101 The HeartMate Left Ventricular Assist Device......Page 104 Arrow LionHeart LVAS......Page 106 The HeartMate II......Page 108 Conclusions......Page 109 References......Page 110 Introduction......Page 111 Implantation Technique......Page 112 United States......Page 113 Europe......Page 114 Discussion......Page 115 References......Page 116 Introduction......Page 117 Development and Design......Page 118 Implantation and Patient Management......Page 119 Conclusion......Page 120 References......Page 121 Introduction......Page 122 Lipid Metabolism......Page 123 Coagulation, Fibrinolysis and Endothelial Function......Page 124 Molecular Approaches for the Treatment of Atherosclerosis......Page 125 Hyperlipidemia......Page 126 Gene Therapy for Vein Graft Failure......Page 127 References......Page 128 Introduction......Page 131 Cellular and Molecular Biology of Angiogenesis......Page 133 Vascular Endothelial Growth Factor......Page 134 Angiogenic Delivery Strategies......Page 135 Clinical Angiogenesis Trials for Advanced Coronary Artery Disease......Page 137 Conclusions......Page 141 References......Page 142 Rationale for Cardiac Xenotransplantation......Page 144 Cellular Transplants......Page 145 Xenotransplantation......Page 146 Barriers to Xenotransplantation......Page 147 The Barriers to Xenotransplantation of Vascularized Organs......Page 148 Physiologic Hurdles to Xenotransplantation......Page 151 Prospects for Application......Page 152 References......Page 153 Subject Index Vol. 101, No. 1–3, 2004......Page 156