Cardiac Surgery in Advanced Heart Failure

Abstract

Mechanical circulatory support and heart transplantation are established surgical options for treatment of advanced heart failure. Since the prevalence of advanced heart failure is progressively increasing, there is a clear need to treat more patients with mechanical circulatory support and to increase the number of heart transplantations. This narrative review summarizes recent progress in surgical treatment options of advanced heart failure and proposes an algorithm for treatment of the advanced heart failure patient at >65 years of age.

Post-transplant survival with pre-transplant durable continuous-flow mechanical circulatory support in a Swiss cohort of heart transplant recipients

“…This observation may relate to the decrease of waitlisted heart transplant candidates with cardiomyopathy of non-ischaemic origin as reported previously from our cohort [6]. However, we cannot exclude a selection bias since patients with heart failure of non-ischaemic origin are prone to a higher incidence of early postoperative right heart failure after CF-MCS implantation [33] and therefore more often considered for urgent transplant surgery [24,34].…”

“…However, the 5-year survival for CF-MCS treatment was only 43.3% in these patients [25], falling short of reported post-transplant 10-year survival of heart transplant recipients documented by the ISHLT registry [4]. This may explain the preference for heart transplantation waitlisting particularly when advanced heart failure presents as monopathology [24]. However, this attitude has worsened the worldwide imbalance between the number of heart transplantation candidates and the number of available donor hearts explaining the worldwide increase in waiting list time [5,6,26].…”

“…From 2009 to 2018, the worldwide number of heart transplant candidates increased substantially due to an increasing proportion of heart transplant candidates aged 65 years and older [23]. Advanced heart failure patients in this age group are usually considered candidates for destination therapy [24].…”

ECMELLA as a bridge to heart transplantation in refractory ventricular fibrillation: A case report

“…Once reassured by the good neurological state, the treatment of the refractory VF was carried out according to the recommendations by a radiofrequency ablation catheter ( 19 ). Unfortunately, due to end-stage ischemic heart disease and recurrences of arrhythmias despite the treatments undertaken, only heart transplantation was a viable option in the short, medium, and long term, as HT remains the best option for end-stage heart failure patients ( 20 ), and is associated with improved outcomes and a better cost–effectiveness profile. In this regard, ECMELLA permitted the discontinuation of sedation, the treatment of the VF by radiofrequency thermoablation and the consent of the patient to be transplanted.…”

Promising directions in the treatment of chronic heart failure: improving old or developing new ones?

“…ст. или при тяжелой аортальной регургитации у всех пациентов с симптомами и бессимптомных больных с ФВ ЛЖ менее или равной 50%, а также об операции по коррекции митральной регургитации (эндоваскулярная постановка клипсы митрального клапана теоретически выглядит более оправданной в ситуации высокого периоперационного риска), в том числе и при вторичной (вследствие дилатации ЛЖ) митральной недостаточности тяжелой степени (особенно у пациентов с ФВ ЛЖ менее 30%), которую не удается корригировать с помощью фармакотерапии и электрофизиологических методов лечения [102,105,107,108].…”