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Treatment options in end-stage heart failure: where to go from here?

Haeck ML, Hoogslag GE, Rodrigo SF, Atsma DE, Klautz RJ, van der Wall EE, Schalij MJ, Verwey HF - Neth Heart J (2012)

Bottom Line: Chronic heart failure is a major healthcare problem associated with high morbidity and mortality.The golden standard treatment for heart failure is heart transplantation after failure of medical therapy, surgery and/or cardiac resynchronisation therapy.In order to improve patients' outcome and quality of life, new emerging treatment modalities are currently being investigated, including mechanical cardiac support devices, of which the left ventricular assist device is the most promising treatment option.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.

ABSTRACT
Chronic heart failure is a major healthcare problem associated with high morbidity and mortality. Despite significant progress in treatment strategies, the prognosis of heart failure patients remains poor. The golden standard treatment for heart failure is heart transplantation after failure of medical therapy, surgery and/or cardiac resynchronisation therapy. In order to improve patients' outcome and quality of life, new emerging treatment modalities are currently being investigated, including mechanical cardiac support devices, of which the left ventricular assist device is the most promising treatment option. Structured care for heart failure patients according to the most recent international heart failure guidelines may further contribute to optimal decision-making. This article will review the conventional and novel treatment modalities of heart failure.

No MeSH data available.


Related in: MedlinePlus

Third-generation HeartWare ventricular assist device (HVAD). This device consists of a magnetically levitated rotor pump that prevents mechanical wear. The pump is implanted in the pericardial space in the apex of the left ventricle. The outflow graft is connected with the ascending aorta. The controller and external batteries are connected to the pump by a percutaneous driveline. In panel A, a chest x-ray is shown of a patient with a HVAD implant and an internal cardioverter defibrillator. Panel B shows the position of all the components of the HVAD system (Panel B reproduced with permission of HeartWare Inc.)
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Fig3: Third-generation HeartWare ventricular assist device (HVAD). This device consists of a magnetically levitated rotor pump that prevents mechanical wear. The pump is implanted in the pericardial space in the apex of the left ventricle. The outflow graft is connected with the ascending aorta. The controller and external batteries are connected to the pump by a percutaneous driveline. In panel A, a chest x-ray is shown of a patient with a HVAD implant and an internal cardioverter defibrillator. Panel B shows the position of all the components of the HVAD system (Panel B reproduced with permission of HeartWare Inc.)

Mentions: Further development led to the third-generation devices consisting of even smaller centrifugal blood pumps (Fig. 3a and b). These pumps have magnetically levitated rotors preventing mechanical wear (Fig. 4). Therefore, it is expected that durability is significantly improved compared with older devices. Because of the small size, the pumps can be implanted intrapericardially further reducing postoperative complications. The first report on the clinical use of the HeartWare ventricular assist device (HVAD) pump (HeartWare Inc, Framingham, MA), a third-generation device, showed in 23 patients promising results with a 6-month and 1-year survival of 91% and 86%, respectively [31]. Infection and bleeding were found to be the most common adverse events. Another multicentre trial using a third-generation VentrAssist LVAD (Ventracor Ltd, Chatswood, NSW, Australia) in 33 patients demonstrated a favourable efficacy and safety profile for the use of this device as bridge to transplant [32]. After a median support time of 142 days, 82% of the patients were either transplanted or remained eligible for transplant. Major adverse events were infections, non-neurological thromboembolic events, neurological events, and haemorrhages. There was a significant improvement in quality of life and 81% of the patients achieved NYHA class I or II at the end of the trial [32].Fig. 3


Treatment options in end-stage heart failure: where to go from here?

Haeck ML, Hoogslag GE, Rodrigo SF, Atsma DE, Klautz RJ, van der Wall EE, Schalij MJ, Verwey HF - Neth Heart J (2012)

Third-generation HeartWare ventricular assist device (HVAD). This device consists of a magnetically levitated rotor pump that prevents mechanical wear. The pump is implanted in the pericardial space in the apex of the left ventricle. The outflow graft is connected with the ascending aorta. The controller and external batteries are connected to the pump by a percutaneous driveline. In panel A, a chest x-ray is shown of a patient with a HVAD implant and an internal cardioverter defibrillator. Panel B shows the position of all the components of the HVAD system (Panel B reproduced with permission of HeartWare Inc.)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3303031&req=5

Fig3: Third-generation HeartWare ventricular assist device (HVAD). This device consists of a magnetically levitated rotor pump that prevents mechanical wear. The pump is implanted in the pericardial space in the apex of the left ventricle. The outflow graft is connected with the ascending aorta. The controller and external batteries are connected to the pump by a percutaneous driveline. In panel A, a chest x-ray is shown of a patient with a HVAD implant and an internal cardioverter defibrillator. Panel B shows the position of all the components of the HVAD system (Panel B reproduced with permission of HeartWare Inc.)
Mentions: Further development led to the third-generation devices consisting of even smaller centrifugal blood pumps (Fig. 3a and b). These pumps have magnetically levitated rotors preventing mechanical wear (Fig. 4). Therefore, it is expected that durability is significantly improved compared with older devices. Because of the small size, the pumps can be implanted intrapericardially further reducing postoperative complications. The first report on the clinical use of the HeartWare ventricular assist device (HVAD) pump (HeartWare Inc, Framingham, MA), a third-generation device, showed in 23 patients promising results with a 6-month and 1-year survival of 91% and 86%, respectively [31]. Infection and bleeding were found to be the most common adverse events. Another multicentre trial using a third-generation VentrAssist LVAD (Ventracor Ltd, Chatswood, NSW, Australia) in 33 patients demonstrated a favourable efficacy and safety profile for the use of this device as bridge to transplant [32]. After a median support time of 142 days, 82% of the patients were either transplanted or remained eligible for transplant. Major adverse events were infections, non-neurological thromboembolic events, neurological events, and haemorrhages. There was a significant improvement in quality of life and 81% of the patients achieved NYHA class I or II at the end of the trial [32].Fig. 3

Bottom Line: Chronic heart failure is a major healthcare problem associated with high morbidity and mortality.The golden standard treatment for heart failure is heart transplantation after failure of medical therapy, surgery and/or cardiac resynchronisation therapy.In order to improve patients' outcome and quality of life, new emerging treatment modalities are currently being investigated, including mechanical cardiac support devices, of which the left ventricular assist device is the most promising treatment option.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands.

ABSTRACT
Chronic heart failure is a major healthcare problem associated with high morbidity and mortality. Despite significant progress in treatment strategies, the prognosis of heart failure patients remains poor. The golden standard treatment for heart failure is heart transplantation after failure of medical therapy, surgery and/or cardiac resynchronisation therapy. In order to improve patients' outcome and quality of life, new emerging treatment modalities are currently being investigated, including mechanical cardiac support devices, of which the left ventricular assist device is the most promising treatment option. Structured care for heart failure patients according to the most recent international heart failure guidelines may further contribute to optimal decision-making. This article will review the conventional and novel treatment modalities of heart failure.

No MeSH data available.


Related in: MedlinePlus