New strategies for surgical management of ischemic cardiomyopathy

Ischemic cardiomyopathy affects an estimated 3 million people in the USA and is the most common cause of heart failure. Traditional operations have included heart transplantation, myocardial revascularization, mitral valve repair, left ventricular reconstruction, first-generation left ventricular assist devices and cardiac resynchronization therapy. These operations have become safer in recent times, due to improved technologies. Current technologies and surgical approaches can benefit a significant number of patients. However, there remains a large group of patients in whom traditional approaches can not be offered. Newer generation ventricular assist devices, passive ventricular restraint devices and cellular-based therapies (including skeletal- and bone marrow-derived stem cells) have the potential to be more universal in their applications. Ongoing investigations with each of these modalities will allow surgeons to offer treatment to patients who are not considered surgical candidates at this time.