Heart failure (HF) is an important cause of morbidity and mortality in sub-Saharan Africa and indeed worldwide. The management of this condition has largely been thought to be within the domain of the Physician with the Surgeon having little or no role to play. The commonest cause of HF that may require surgical intervention is rheumatic valvular heart disease especially in the young age group while ischaemic heart disease still remains at the low rung of the ladder and interestingly, hypertrophic cardiomyopathy is becoming common. Most of the literatures reviewed failed to identify pericardial diseases, though it ranked topmost in the face of tuberculosis and HIV infections in the sub-region, and the other non-cardiac structures as important causes of HF which is amenable to surgical intervention. Equally, what have not been clearly identified are the surgical aspects; indeed its sub-classifications into heart and non-heart causes have hitherto not been documented. Even though these lists from this review are not exhaustive of the numerous unidentified causes of surgical HF, this would act as stimulus for further and extensive documentation of guideline for the recognition of these sub-classifications of HF amenable to surgery.