Surgical Options

• Coronary bypass surgery - in the setting of ischemic cardiomyopathy with adequate coronary targets, coronary bypass grafting remains the preferred therapy. This often can be performed with relatively low risk with excellent long-term results reducing the subsequent need for heart transplantation.
• Patients with congestive heart failure and severe mitral regurgitation are candidates for mitral valve repair with marked improvement in their symptoms of heart failure. Usually this can be performed without the need to replace the mitral valve. These patients often have annular dilatation with essentially normal mitral valve leaflets that fail to coapt properly. By placing a smaller size annular ring, the leaflets are brought into approximation thereby improving the mitral regurgitation. Severe left ventricular dysfunction is not a contraindication to this procedure.
• Ischemic cardiomyopathy with akinetic or dyskinetic anterior wall - these patients are candidates for high-risk coronary bypass surgery with a modified DOR procedure (left ventricular reconstruction) to restore the normal geometry of the left ventricle thereby improving symptoms of left ventricular failure and relieving angina.
• Heart transplantation - heart transplantation remains an excellent option for patients who have exhausted all medical and surgical therapies for their congestive heart failure. It continues to be limited by donor availability but short and long-term results are outstanding with an expected 60% survival at ten years.

Transplant Center