Surgical Alternatives to Heart Transplantation
Chronic heart failure, as the end stage of coronary heart disease, is the most important challenge facing cardiac medicine in the coming decades.
Great progress has been made in pharmacological treatment and electrostimulation therapy but surgical procedures are still necessary. Heart transplantation can help only a small number of relatively young patients.
Mechanical circulatory support systems, implanted for long-term use, are playing an increasingly important role, with ever improving results. Other organ-preserving procedures that also improve the heart function, such as revascularization, mitral valve reconstruction, and ventricular reconstruction can delay the need for heart transplantation in individual cases.
Fig. 1. Heart failure: surgical options
The common complex known as “LOCIMAN” (left ventricular failure, obstruction of the coronary arteries, mitral valve insufficiency, left ventricular aneurysm) depends on the relative importance of the components hibernating myocardium, mitral valve insufficiency and ventricular scarring.
Fig. 2: The LOCIMAN complex
Research into the individual functional significance of these components and the efficiency of the surgical steps mentioned above are the subject of a large research project at the DHZB. One important aim is to characterize patients who will benefit from organ-preserving operations and those who are candidates for the implantation of long-term artificial pumping systems.
