Heart failure surgery rapidly evolves. Leading cardiac surgeon explains trends in ventricular assist devices, minimally invasive heart failure surgery, and future expectations. Let’s talk about heart failure surgery. Professor Lawrence Cohn was a pioneer in minimally invasive heart valve surgery. Dr. Anton Titov, MD. We had a conversation a couple of years ago. Professor Cohn said that surgery for heart failure is where we can expect a lot of progress in the near future. Dr. Anton Titov, MD. What are the recent advances in heart failure surgery? Dr. Marc Pelletier, MD. The biggest advances have been on the front of mechanical support. Heart failure in the Western world is becoming one of the biggest problems. Patients have had prior heart attacks. Patients have heart failure from different causes. Sometimes heart failure is correctable with an operation to replace a heart valve. Sometimes coronary artery bypass graft surgery cures heart failure. Dr. Marc Pelletier, MD. But for a lot of patients heart failure becomes irreversible. There comes a point that the heart is not recoverable no matter what you do. Heart transplantation has been a wonderful option for many of heart failure patients. But many patients are not eligible for heart transplantation. The heart transplantation waiting list could be so long for some of heart failure patients. They would die before they get a new heart. The advances in left ventricular assist devices have been really remarkable. Temporary support of patient’s heart with the ventricular assist device has been remarkable. We call it a VAD. Dr. Marc Pelletier, MD. There is technology now with rotating pumps as opposed to the old pulsatile pumps. The size of ventricular assist devices is now much much smaller than it was. More importantly, the durability of ventricular assist devices is now so much better than what it used to be. Dr. Marc Pelletier, MD. We have heart failure patients with ventricular assist devices walking around. They enjoy a great life on a ventricular assist device now for years and years. That did not exist 5 or 10 years ago. That is where we've seen the biggest advances in heart failure treatment. In the future we will see see a better durability of heart failure treatment devices. Durability seems to be better and better all the time. You are going to see this remarkable treatment option. Dr. Anton Titov, MD. You can put a small mechanical heart inside of them. This mechanical heart fits in the palm of your hand. That artificial heart can keep a patient with heart failure alive for years and years. That will be option for some heart failure patients. They otherwise are dying and have no other therapy option. We are already starting to see mechanical hearts now. Dr. Marc Pelletier, MD. We are going see more of that in the future. Those ventricular assist devices or different forms of VAD devices has been a big advance for us in the last ten years. Ventricular assist devices can keep a patient alive when a patient comes in with a terrible heart attack. VAD devices help patients where their hearts not working at all. We can also put somebody on ECMO circulatory support to at least keep them alive. ECMO helps patient’s organs recover. Then sometimes their heart recovers too. ECMO is extracorporeal membrane oxygenation. Dr. Marc Pelletier, MD. Surgeons now can put in a mechanical device through a small incision just below the clavicle or through the groin. This emergency surgery allows to at least temporize patient’s situation. It can buy patients some time to recover. Dr. Anton Titov, MD. Again that technology and the ability for us to use that technology has really increased a lot in the last few years.