Devices in the management of advanced, chronic heart failure

Abstract

Heart failure (HF) is a global phenomenon, and the overall incidence and prevalence of the condition are steadily increasing. Medical therapies have proven efficacious, but only a small number of pharmacological options are in development. When patients cease to respond adequately to optimal medical therapy, cardiac resynchronization therapy has been shown to improve symptoms, reduce hospitalizations, promote reverse remodelling, and decrease mortality. However, challenges remain in identifying the ideal recipients for this therapy. The field of mechanical circulatory support has seen immense growth since the early 2000s, and left ventricular assist devices (LVADs) have transitioned over the past decade from large, pulsatile devices to smaller, more-compact, continuous-flow devices. Infections and haematological issues are still important areas that need to be addressed. Whereas LVADs were once approved only for ‘bridge to transplantation’, these devices are now used as destination therapy for critically ill patients with HF, allowing these individuals to return to the community. A host of novel strategies, including cardiac contractility modulation, implantable haemodynamic-monitoring devices, and phrenic and vagus nerve stimulation, are under investigation and might have an impact on the future care of patients with chronic HF.

Cardiac 123I-MIBG Imaging for Clinical Decision Making: 22-Year Experience in Japan

“…Conversely, even patients outside the indication criteria may die of SCD (consequently at a high risk) and are eligible for treatment. Besides device-related problems, the increasing need for medical resources, which are becoming limited, heightens the need to establish more appropriate identificationbeyond that provided by conventional clinical markers-of patients who have chronic HF and are most likely or unlikely to benefit from device treatment in a cost-effective fashion (48)(49)(50)(51).…”

Durable Mechanical Circulation Support as an Alternative to Heart Transplantation

“…Методы длительной механической поддержки кровообращения могут быть применены в следую-щих случаях [16]: -«мост» для последующей трансплантации до-норского сердца больным, находящимся в листе ожидания (bridge to transplant -BTT); -имплантация насоса с целью восстановления насосной функции миокарда (bridge to recovery -BTR); -имплантации насоса на постоянной основе (destination therapy -DT) в случаях, когда па-циент по каким-либо причинам не может быть включен в лист ожидания донорского органа (возраст, хронические заболевания, религиозные убеждения и др.). Среди наибольших преимуществ ДМПК по сравнению с трансплантацией сердца является то, что пациенты могут избежать длительного ожида-ния донорского сердца в листе ожидания, будучи зависимыми от напряженной медикаментозной пе-роральной или парентеральной инотропной тера-пии; отсутствует риск отторжения трансплантата и осложнений посттрансплантационной терапии, а при наличии противопоказаний к трансплантации сердца является фактически единственным шансом для продолжения жизни.…”

Recent Advances in the Optimization of Cardiac Resynchronization Therapy

“…The field of resynchronization therapy has evolved over the past two decades to smarter devices with capabilities for remote hemodynamic monitoring and novel pacing algorithms. In addition, our understanding of the pathophysiology of chronic heart failure, mechanisms of CRT response, and novel lead placement techniques have made the delivery of CRT more effective [4]. This review article is intended to discuss the mechanisms and benefits of CRT, clinical trials, and guidelines for CRT along with a focus on recent updates from the past 3 to 5 years and glimpse into future directions.…”