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Ann Thorac Surg 2003;76:S2254-S2259
© 2003 The Society of Thoracic Surgeons

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Supplement: Gibbon & His Heart-Lung Machine

Surgical treatment of congestive heart failure: evolving options

^a Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland, USA

^* Address reprint requests to Dr Griffith, Division of Cardiac Surgery, University of Maryland, N4W94, 22 S Greene St, Baltimore, MD 21201, USA
e-mail: bgriffith@smail.umaryland.edu

Presented at the symposium, "Gibbon & His Heart-Lung Machine: 50 Years & Beyond," Philadelphia, PA, May 2, 2003.

The first 300 words of the full text of this article appear below.

I am most pleased to be included in this wonderful symposium to honor John Gibbon and his contributions to cardiopulmonary bypass. It is special to me as a graduate of Jefferson Medical College to discuss surgical treatment of congestive heart failure as I have formed much of my interest in the areas that intrigued Dr Gibbon. Since leaving this school I have had unbridled opportunities to research and clinically explore extracorporeal membrane oxygenation, heart and lung transplantation, and mechanical circulatory support. It is important to review the current trends in surgical management because congestive heart failure afflicts more than 4.9 million Americans and consumes more than 5% of the total US health care dollars ($40 billion) [1]. Our specialty's response to the need is critical for those suffering and for cardiac surgeons who adapt to nonsurgical advances in coronary artery disease. My discussion will include the role for myocardial revascularization, mitral valve repair, left ventricular remodeling, mechanical circulatory support, and transplantation for those with heart failure.

Patients are often referred for consideration of revascularization when they have considerable left ventricular dysfunction based on established trials [2–5]. In the past much attention has been focused on the factors that influence surgical mortality [6–16]. These include quality of surgical targets, symptomatic status of the patient, level of pulmonary artery pressure, acuteness of presentation, and overall state of the patient at presentation. Surgical mortality is now an acceptable 2.3% to 5.0%. However a number of patients have been referred to us for consideration of transplantation when they have severely depressed left ventricular function and with unclear viability. The assessment of myocardial viability has improved and now permits the differentiation of myocardial fibrosis from hibernation [17, 18]. In the latter, coronary revascularization . . . [Full Text of this Article]

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