Surgical treatment for severe heart failure: recent progress in treatment strategy and its present status in Japan.

Chronic intractable heart failure that is unresponsive to maximum medical therapy can have a wide variety of causes; these include advanced valvular diseases and severe myocardial ischemia, ischemic cardiomyopathy (ICM) in heart failure following extensive myocardial infarction, chronic heart failure due to dilated cardiomyopathy (DCM) in which the myocardium itself is progressively damaged or the acute aggravation of the latter. Heart transplantation has long been considered the only useful treatment for patients with heart failure due to ICM- and DCM-induced severe left ventricular hypofunction. However, because of the extremely limited number of heart transplant donors, other surgical treatments have also been attempted. In this communication, we provide an overview of the current situation with regard to left ventriculoplasty and heart transplantations, as well as of the treatment of severe heart failure using ventricular assist devices, which have recently shown remarkable progress.