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Durable Mechanical Circulatory Support versus Organ Transplantation: Past, Present, and Future.

Anand J, Singh SK, Antoun DG, Cohn WE, Frazier OH, Mallidi HR - Biomed Res Int (2015)

Bottom Line: For more than 30 years, heart transplantation has been a successful therapy for patients with terminal heart failure.Because of donor scarcity and limited long-term survival, heart transplantation has had a trivial impact on the epidemiology of heart failure.Surgical implementation of MCS, both for short- and long-term treatment, affords physicians an opportunity for dramatic expansion of a meaningful therapy for these otherwise mortally ill patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Baylor College of Medicine and Center for Cardiac Support, Texas Heart Institute, Houston, TX 77030, USA.

ABSTRACT
For more than 30 years, heart transplantation has been a successful therapy for patients with terminal heart failure. Mechanical circulatory support (MCS) was developed as a therapy for end-stage heart failure at a time when cardiac transplantation was not yet a useful treatment modality. With the more successful outcomes of cardiac transplantation in the 1980s, MCS was applied as a bridge to transplantation. Because of donor scarcity and limited long-term survival, heart transplantation has had a trivial impact on the epidemiology of heart failure. Surgical implementation of MCS, both for short- and long-term treatment, affords physicians an opportunity for dramatic expansion of a meaningful therapy for these otherwise mortally ill patients. This review explores the evolution of mechanical circulatory support and its potential for providing long-term therapy, which may address the limitations of cardiac transplantation.

No MeSH data available.


Related in: MedlinePlus

Adverse events associated with continuous- and pulsatile-flow LVADs—this chart illustrates a comparison of adverse events between continuous-flow and pulsatile-flow support listed as events per patient years. Those differences with a significant P value (<0.05) are indicated by an “∗” [22].
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fig4: Adverse events associated with continuous- and pulsatile-flow LVADs—this chart illustrates a comparison of adverse events between continuous-flow and pulsatile-flow support listed as events per patient years. Those differences with a significant P value (<0.05) are indicated by an “∗” [22].

Mentions: In 2009, the results of a landmark trial [22] were reported, comparing the pulsatile, first-generation HeartMate XVE with the CF HeartMate II device. The study included 200 patients with a left ventricular ejection fraction of less than 25%, peak oxygen consumption of less than 14 mL/kg/min, NYHA class IIIB or IV symptoms, or the need for an intra-aortic balloon pump or inotropic therapy. Actuarial survival was significantly improved in the HeartMate II group compared to the HeartMate XVE group (68% versus 55%, resp., at 1 year and 58% versus 24% at 2 years; Figure 3). Adverse event rates were also significantly reduced with the HeartMate II (Figure 4).


Durable Mechanical Circulatory Support versus Organ Transplantation: Past, Present, and Future.

Anand J, Singh SK, Antoun DG, Cohn WE, Frazier OH, Mallidi HR - Biomed Res Int (2015)

Adverse events associated with continuous- and pulsatile-flow LVADs—this chart illustrates a comparison of adverse events between continuous-flow and pulsatile-flow support listed as events per patient years. Those differences with a significant P value (<0.05) are indicated by an “∗” [22].
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4637061&req=5

fig4: Adverse events associated with continuous- and pulsatile-flow LVADs—this chart illustrates a comparison of adverse events between continuous-flow and pulsatile-flow support listed as events per patient years. Those differences with a significant P value (<0.05) are indicated by an “∗” [22].
Mentions: In 2009, the results of a landmark trial [22] were reported, comparing the pulsatile, first-generation HeartMate XVE with the CF HeartMate II device. The study included 200 patients with a left ventricular ejection fraction of less than 25%, peak oxygen consumption of less than 14 mL/kg/min, NYHA class IIIB or IV symptoms, or the need for an intra-aortic balloon pump or inotropic therapy. Actuarial survival was significantly improved in the HeartMate II group compared to the HeartMate XVE group (68% versus 55%, resp., at 1 year and 58% versus 24% at 2 years; Figure 3). Adverse event rates were also significantly reduced with the HeartMate II (Figure 4).

Bottom Line: For more than 30 years, heart transplantation has been a successful therapy for patients with terminal heart failure.Because of donor scarcity and limited long-term survival, heart transplantation has had a trivial impact on the epidemiology of heart failure.Surgical implementation of MCS, both for short- and long-term treatment, affords physicians an opportunity for dramatic expansion of a meaningful therapy for these otherwise mortally ill patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Baylor College of Medicine and Center for Cardiac Support, Texas Heart Institute, Houston, TX 77030, USA.

ABSTRACT
For more than 30 years, heart transplantation has been a successful therapy for patients with terminal heart failure. Mechanical circulatory support (MCS) was developed as a therapy for end-stage heart failure at a time when cardiac transplantation was not yet a useful treatment modality. With the more successful outcomes of cardiac transplantation in the 1980s, MCS was applied as a bridge to transplantation. Because of donor scarcity and limited long-term survival, heart transplantation has had a trivial impact on the epidemiology of heart failure. Surgical implementation of MCS, both for short- and long-term treatment, affords physicians an opportunity for dramatic expansion of a meaningful therapy for these otherwise mortally ill patients. This review explores the evolution of mechanical circulatory support and its potential for providing long-term therapy, which may address the limitations of cardiac transplantation.

No MeSH data available.


Related in: MedlinePlus