Annotation Congestive heart failure (CHF) is one of the most common killers worldwide and is becoming more prevalent as the population continues to age. Despite great advances in medical drug treatment and the liberal use of pacemakers and internal defibrillators, the outcome of CHF remains poor, which has prompted investigators to consider new surgical options for its management. This special issue compiles contributions from a select group of investigators and experts from premier medical centers. It covers many important topics, including aortic valve replacement for valvular cardiomyopathy, mitral valve repair, myocardial revascularization in patients with ventricular dysfunction, the pros and cons of beating heart versus on-pump coronary artery bypass surgery (CABG), and clinical trials comparing CABG to percutaneous coronary interventions. The ongoing clinical trials in the surgical management of CHF, the experience with ventricular reduction and remodeling surgery as well as the current status of heart transplantation are reviewed. Consideration is also given to resynchronization therapy and biventricular pacing for CHF, and the use of ventricular assist devices as destination therapy and as a bridge to transplantation or recovery. The reader is updated on the clinical experience with the Jarvik 2000 ventricular assist device and the AbioCor total artificial heart. Further novel approaches discussed are gene therapy for premature coronary artery disease, therapeutic angiogenesis, transmyocardial laser revascularization and cardiac xenotransplantation. This publication will be of special interest to clinicians and investigators in cardiology and cardiac surgery, medical and surgical residents and fellows in training, and general practitioners.