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Optimal management of heart failure is collaborative, with involvement of specialist heart failure physicians, nurses, interventionalists and surgeons. In addition to medical optimisation and cardiac resynchronisation therapy, surgery plays a valuable role in many patients. We herein detail the evidence behind and role for surgical intervention in functional mitral regurgitation, coronary revascularisation in ischaemic cardiomyopathy, and surgical ventricular reconstruction. Additionally, we describe techniques of temporary and durable mechanical circulatory support, with their relative advantages and disadvantages and applications. Finally, we describe the history and nomenclature around heart transplant, its indications, techniques, present-day outcomes, complications, and new developments in the field.