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Future Perspectives

There are many potential surgical “targets” in heart failure patients, especially for patients with ischemic cardiomyopathy. The most widely used surgery for heart failure is coronary artery bypass, and with the aid of viability studies, this appears to be effective therapy to reduce the risk of death versus medical therapy. Overall, heart surgery is not as dangerous as it used to be in this population of patients. Furthermore, recent randomized trials in mitral valve surgery and patients with low LVEF indicate that this is more widely applicable than at just a handful of specialized centers. Despite the discouraging results of the STICH trial, there may be a discrete population of patients with localized LV infarction and dilation that may benefit from LV reconstruction. As surgical and anesthesia management of heart failure continues to improve, maximizing the surgical options for patients referred for heart transplantation may help diminish the wait times for …