Should Patients who have Persistent Severe Symptoms Receive a Left Ventricular Assist Device or Cardiac

John Cleland, MD, FESC, FACC*, Ahmed Tageldien, MSc, MD, Olga Khaleva, MD, Neil Hobson, MBBS, Andrew L. Clark, MD University of Hull, Castle Hill Hospital, Kingston-upon-Hull, UK Many patients who have heart failure experience severe recurrent or persistent symptoms despite standard pharmacologic treatment with diuretics, ACE inhibitors or angiotensin receptor blockers, aldosterone antagonists, and beta-blockers 1-3 . Careful review of standard medication may identify that the dose of one or...

Can Be Fixed

Leaflet Coaptation

Bolling, MD* University of Michigan, Ann Arbor, MI, USA Congestive heart failure (CHF) is a significant health burden whose impact is increasing around the world. As our population ages, medical advances that have extended our average life expectancy have also left more people living with chronic cardiac disease than ever before. In the United States alone, there are nearly 4.9 million suffering with heart failure with over 500,000 new patients diagnosed each...

Current limitations of destination mechanical circulatory support devices

Current destination mechanical circulatory support devices limitation 1 infections Infection causes substantial morbidity and mortality after MCSD implantation and reduces the survival and QoL benefit 23-28 . As opposed to the risk of coagulopathies, which occur early after MCSD-implantation, the risk of infection increases linearly (Fig. 1) 21 . Infection can develop in the percutaneously placed drive line, the generator pocket, and the bloodstream and is often initiated by mechanical...

Symptomatic relief with cardiac resynchronization therapy placement

In patients who have advanced HF and a prolonged QRS interval, CRT has been shown to improve symptoms and hemodynamics, increase exercise tolerance, and decrease the risk of death from any cause 30-33 . In the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) study, CRT resulted in clinical improvement in patients who had moderate-to-severe HF (LVEF < 35 ) and an intraventricular conduction delay (QRS interval > 130 msec) 33 . After 6 months, the 228 CRT patients could walk...

Stephen Westaby MS PhD FRCS

Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK Chronic heart failure affects around 5 million North Americans and 7 million Europeans each year, accounting for 2 of the total health care budget in Western countries 1 . The major component of health care costs is repeated hospital admissions to palliate intolerable symptoms and escalate medical treatment. It is estimated that between 250,000 and 500,000 patients in the United States and approximately 2.2 million worldwide are in the...

Role of surgical treatment in patients who have advanced heart failure

High-risk revascularization may constitute the treatment of choice in the subgroup of advanced heart failure patients who have ischemic cardio-myopathy, an ejection fraction less than 35 , viable myocardium, and vessels suitable for grafting. The NIH-sponsored Surgical Treatment for Ischemic Heart Failure (STICH) trial includes 2800 patients to evaluate whether surgical coronary revascularization in addition to aggressive medical heart failure management confer long-term mortality, morbidity,...

Role of electrophysiological treatment in patients who have advanced heart failure

The use of implantable devices to resynchron-ize ventricular contraction may be a beneficial adjunct in the treatment of selected patients who have chronic heart failure. The hypothesis that multisite biventricular pacing may improve myo-cardial remodeling, hemodynamics, and well- being by reducing ventricular asynchrony, lead to introducing the cardiac resynchronization therapy modality for the management of patients who have advanced heart failure. The Multisite Stimulation in...