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| Treatment of heart failure is the largest expenditure in most hospitals. The various causes of heart failure or cardiomyopathies are ischemic, valvular, familial, viral and idiopathic. Medical management for heart failure is the first line treatment but this may not be adequate in all patients. Heart transplantation remains the gold standard to compare outcomes in surgical treatment. Success with transplantation is 80-90% with the limiting factor being a lack of donors to meet demand. There are about 2000 heart transplants performed in the USA per year with over 20,000 people waiting for a heart. Fortunately there may be other management options for these patients. The development of artificial heart devices continues to offer alternatives for some. Presently many of these devices are used as bridges for transplant, such as the TCI Heartmate and Novocore. Totally implantable devices which may offer complete replacement are currently in development and limited trials. Two other surgical operations which offer additional armentarium in the management of CHF are the Batista (ventricular remodeling) and cardiomyoplasty. | |||
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