The role of surgery in acute heart failure

Acute heart failure is a syndrome of myocardial dysfunction whereby systemic blood flow falls to levels inadequate to preserve end organ function. Many cases are superimposed upon chronic heart failure. Eleven per cent die during the acute hospital admission and 30% within 1 year. Urgent surgical treatment is used for valve disruption in endocarditis and for complications of myocardial infarction, including ventricular septal or free wall rupture, and mitral regurgitation. Coronary bypass grafting occasionally plays a role in the revascularization strategy during acute infarction. Increasingly surgeons play an important role in rescue from profound cardiogenic shock by deploying temporary left or biventricular assist devices as bridge to myocardial recovery, transplantation or a long term implantable blood pump. Some devices are easily portable allowing rescue in a district general hospital, then transportation to the tertiary care centre. Between 40 and 70% of patients who would otherwise die, can be salvaged with different pumps selected according to clinic indication. In contrast the widely used intra-aortic balloon pump provides no survival benefit in established cardiogenic shock.