Despite the significant decline in heart disease mortaht>' rates over the last 25 years, heart failure has remained a significant problem. We are now confronted with large numbers of terminally ill patients for whom conventional therapies for heart failure have been exhausted and for whom repeated hospital visits are necessary. There now is a major thrust towards a management strategy which embraces a comprehensive approach including vigorous preventive measures and earlier surgical interventions. This book outlines the major surgical options for the treatment of heart failure and brings together a very broad base of opinions with contributions from several outstanding individuals. With the improved knowledge and techniques to control rejection, transplantation has become the central pillar in the surgical management of this group of patients. Unfortunately, because of limited donor supply the teclmique cannot be applied to large numbers of patients. A great deal of excitement, however, exists in the potential for xenotransplantation as a supplement to homotransplantation. The use of cardiac assist devices has become a reality with several hundred LVADS and BiVADS implanted throughout the world and cardiac replacement with total artificial hearts continues to be used successfully as a bridge to transplantation. We are on the thieshold of the broad application of assist devices to provide prolonged relief of heart failure and restore patients to an ambulatoiy home environment and hopefully return to the work force in significant numbers.

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List of Contributors. Introduction; W.J. Keon. 1. Pathophysiology of Contractile Dysfunction in Heart Failure; N.S. Dhalla, et al. 2. Coronary Artery Bypass for Advanced Left Ventricular Dysfunction; J. Elefteriades, et al. 3. Valve Surgery for Regurgitant Lesions of the Aortic or Mitral Valves in Advanced Left Ventricular Dysfunction; R.O. Bonow, R.G. Masters. 4. Left Ventricular Aneurysm Repair for the Management of Left Ventricular Dysfunction; W.J. Keon, L.C. Semelhago. 5. Selection and Management of the Potential Candidate for Cardiac Transplantation; L.W. Stevenson. 6. The Registry of the International Society for Heart and Lung Transplantation: Fifteenth Official Report - 1998; J.D. Hosenpud, et al. 7. Mechanical Circulatory Support; J. Helou, R.L. Kormos. 8. Dynamic Cardiomyoplasty; V. Badhwar, et al. 9. Partial Left Ventriculectomy; R.J. Kaplon, P.M. McCarthy. 10. Xenotransplantation; F.N.K. Bhatti, J. Wallwork. 11. Permanent Mechanical Circulatory Support; T. Mussivand, et al.