Surgical Interventions for Advanced Heart Failure

Abstract The prevalence of advanced heart failure (HF) is increasing with the aging population, with a high mortality rate despite guideline-directed medical therapy. Mechanical circulatory support and heart transplantation (HTx) are definitive treatments for patients with advanced HF. Temporary mechanical circulatory support devices, such as intra-aortic balloon pumps and extracorporeal membrane oxygenation, can be used to stabilize acute cases, while third-generation left ventricular assist devices, such as the HeartMate 3, provide durable support with reduced complications. However, HTx remains the gold standard, offering a median survival exceeding 15 years, although donor shortages limit its availability. Innovations in donor utilization and xenotransplantation aim to address this gap. Furthermore, timely referral, risk stratification, and multidisciplinary care are crucial to optimize outcomes. Continued advancements in mechanical circulatory support and HTx promise improved survival and quality of life for patients with advanced HF. This review highlights the evolving roles of mechanical circulatory support and HTx in the management of advanced HF, emphasizing timely intervention, individualized treatment, and ongoing innovation to improve patient outcomes.