Surgical therapies for heart failure--making the tool belt for heart failure bigger.

In a recent excellent editorial message, Dr. Dean Ornish emphasized to all of us the need to use diet and lifestyle measures as well as statin therapies for patients with hyperlipidemias—in other words, he urged us to not fail to use all of the tools in our tool belt.1 And so it is with heart failure; we have long paid attention (or lip-service it sometimes seems) to the many other options for treating patients with symptomatic heart failure including the roles of dietary salt restriction, exercise, smoking cessation, stress reduction, and so on. In this issue of Congestive Heart Failure, and in issues to come, papers on surgical therapies for heart failure are part of the content, along with drug therapies such as diuretics and angiotensin II receptor blockers. At first glance one might say that surgical therapies such as coronary artery bypass surgery and heart transplantation have long been important parts of our heart failure armamentarium. However, beginning to think about surgical approaches as a “standard” or “routine” is in fact going to be a bit of a culture shift for some. As our understanding of the pathophysiology of heart failure grows and we recognize that once developed, heart failure in many ways begets itself, so, too, will our understanding and acceptance of surgical therapies for heart failure. This step is critical, I believe, since my observation has been that aside from the few “early adopters” of new surgical approaches, most professionals taking care of patients with advanced heart failure often share the lay perspective that a patient is so sick—they might not “make it through” the surgical procedure—when, in fact, without a surgical correction, the patient will most certainly die. And so, as we have learned about many of our drug therapies with heart failure (treating earlier is better), we need to get over the cultural shock of what a surgical therapy really is—a big fix for a big problem that has gone on too long. It is incumbent on our surgical colleges and device manufacturers as well to begin to reduce the surgical intensity needed to effect a surgical treatment. So as you read the reviews in this issue of CHF be reminded that they are here because this is where they need to be—in the hands and minds of the heart failure therapists of the world. And if this is a little uncomfortable for you right now, I suggest you try, as Suzuki implored us, to keep a “beginner’s mind.”