• Coutinho E SilvaRaphael Dos SantosRDS0000-0001-8818-5043Laboratorio Cirurgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., ZanoniFernando LuizFL0000-0003-4182-6864Laboratorio Cirurgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR., Rafael Simas, and MoreiraLuiz Felipe PinhoLFP0000-0003-0179-4976Laboratorio Cirurgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR..
• Laboratorio Cirurgico de Pesquisa Cardiovascular (LIM-11), Instituto do Coracao (Incor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
• Clinics (Sao Paulo). 2021 Jan 1; 76: e3248.

AbstractSurgical neuromodulation therapies are still considered a last resort when standard therapies have failed for patients with progressive heart failure (HF). Although a number of experimental studies have provided robust evidence of its effectiveness, the lack of strong clinical evidence discourages practitioners. Thoracic unilateral sympathectomy has been extensively studied and has failed to show significant clinical improvement in HF patients. Most recently, bilateral sympathectomy effect was associated with a high degree of success in HF models, opening the perspective to be investigated in randomized controlled clinical trials. In addition, a series of clinical trials showed that bilateral sympathectomy was associated with a decreased risk of sudden death, which is an important outcome in patients with HF. These aspects indicates that bilateral sympathectomy could be an important alternative in the treatment of HF wherein pharmacological treatment barely reaches the target dose.

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