The Surgical Evolution of Managing Chronic Heart Failure

Heart failure (HF) is a clinical syndrome that results from structural and functional defects in the myocardium, which lead to impaired ventricular filling or reduced capacity to eject blood. HF is a major global health issue that affects more than 64 million people worldwide and has an annual incidence of approximately 500,000 new cases in the United States alone ( ). According to the Heart and Stroke Foundation, there are 750,000 people living with HF in Canada, where more than 100,000 people are diagnosed with HF each year ( ). It is also estimated that HF will burden the Canadian healthcare system by more than $2.8 billion/year by 2030. There is also a significant societal impact as less than 70% of HF patients are on the appropriate medications in Canada ( ). The most common cause for HF is impaired left ventricular (LV) function. Although medications have shown safety and efficacy in alleviating symptoms and reducing some risk factors, there is presently no effective cure for chronic HF. Moreover, patients suffering from HF do not develop or present with symptoms until the later stages of compromised cardiac function. As a result, adjunct and more definitive management strategies, including mechanical circulatory support (MCS) devices and heart transplantation, are often required for treating chronic HF. The purpose of this paper is to summarize and present the surgical evolution of chronic heart failure management. To do so, we review the types of mechanical circulatory assist devices, their development over the past six decades, and the current state of cardiac transplantation (Figure 1).