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Mechanical circulatory support for advanced heart failure.

Publication ,  Journal Article
Patel, CB; Alexander, KM; Rogers, JG
Published in: Curr Treat Options Cardiovasc Med
December 2010

Both acute and chronic systolic heart failure can progress to an advanced phase, resulting in stage D heart failure and even cardiogenic shock. Despite significant progress in the treatment of systolic heart failure using medical and device therapies, this terminal phase continues to be prevalent and associated with unacceptably high morbidity and mortality. Given the inability to offer cardiac transplantation to the majority of those presenting with advanced heart failure, alternative strategies for cardiac replacement therapy are often required. Although there has been interest in using mechanical devices to support the circulation since the advent of cardiopulmonary bypass, it is only in the past 20 years that ventricular assist devices (VAD) have become viable options for therapy. Indeed, we are now entering an era where circulatory assist devices are being used not only to temporarily support patients with post-cardiotomy shock, but also as a long-term treatment in ambulatory heart failure patients. Furthermore, we are now able to utilize data from multicenter trials and registries to guide treatment decisions. These data have clearly shown that VADs improve survival and quality of life in patients with advanced heart failure when implanted as a temporary measure (bridge to recovery and bridge to transplant) or as long-term support (destination therapy). However, with a growing heart failure population there is much work to be done to improve VAD technology, patient selection, post-implantation management, and to define the optimal role for assist devices in the management of systolic heart failure. We are also in the nascent stages of fully understanding the impact of mechanical support on the failing myocardium, and developing research methodologies to study novel therapies in tandem with VADs to facilitate ventricular recovery. These important questions are currently being addressed in ongoing clinical trials, registry analyses, and translational research endeavors.

Duke Scholars

Published In

Curr Treat Options Cardiovasc Med

DOI

EISSN

1534-3189

Publication Date

December 2010

Volume

12

Issue

6

Start / End Page

549 / 565

Location

United States

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
 

Citation

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ICMJE
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Patel, C. B., Alexander, K. M., & Rogers, J. G. (2010). Mechanical circulatory support for advanced heart failure. Curr Treat Options Cardiovasc Med, 12(6), 549–565. https://doi.org/10.1007/s11936-010-0093-6
Patel, Chetan B., Kevin M. Alexander, and Joseph G. Rogers. “Mechanical circulatory support for advanced heart failure.Curr Treat Options Cardiovasc Med 12, no. 6 (December 2010): 549–65. https://doi.org/10.1007/s11936-010-0093-6.
Patel CB, Alexander KM, Rogers JG. Mechanical circulatory support for advanced heart failure. Curr Treat Options Cardiovasc Med. 2010 Dec;12(6):549–65.
Patel, Chetan B., et al. “Mechanical circulatory support for advanced heart failure.Curr Treat Options Cardiovasc Med, vol. 12, no. 6, Dec. 2010, pp. 549–65. Pubmed, doi:10.1007/s11936-010-0093-6.
Patel CB, Alexander KM, Rogers JG. Mechanical circulatory support for advanced heart failure. Curr Treat Options Cardiovasc Med. 2010 Dec;12(6):549–565.
Journal cover image

Published In

Curr Treat Options Cardiovasc Med

DOI

EISSN

1534-3189

Publication Date

December 2010

Volume

12

Issue

6

Start / End Page

549 / 565

Location

United States

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology