Destination therapy: An alternative for end-stage heart failure patients not eligible for heart transplantation

Martin Cadeiras, Manuel Prinz Von Bayern, Amandeep Pal, Tomohiro Asai, Yoshifumi Naka, Mario C. Deng

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Purpose of review: Evidence on survival and quality-of-life benefit from destination mechanical circulatory support has been available since the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial and the database of the International Society of Heart and Lung Transplantation is continuously providing information on outcomes. Limited survival, resource allocation, and expanding indications should prompt careful identification of patients most likely to benefit and list program requirements to reconcile patient outcomes with a public health rationale. Recent findings: Suitable candidates should be identified early and referred to centers experienced in all aspects of terminal heart failure care. Extensive studies on pulsatile and nonpulsatile devices are needed, including randomized clinical trials. Coagulopathies are still common early after device implantation whereas infections increase linearly, limiting 1-year survival. Right-sided heart failure should be identified and accurately evaluated, especially in the older population. Arrhythmias unlikely complicate outcomes and improvements in device design can reduce device-related complications. Summary: Indication for destination mechanical circulatory support devices is rapidly increasing and benefit will most likely be obtained if evaluation is systematic and complications are foreseen. Assessment and prediction of organ dysfunction recovery are challenging and several new innovative risk tools might help aid clinical algorithms. Advanced age, renal failure, and right-sided heart failure are related to worst survival, and first consensus guidelines for evaluation and decision-making algorithms have been outlined. Innovative translational medical research, including use of high-throughput genomics, will potentially improve patient selection and might ensure a better survival.

Original languageEnglish (US)
Pages (from-to)369-375
Number of pages7
JournalCurrent Opinion in Organ Transplantation
Volume10
Issue number4
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

Fingerprint

Heart Transplantation
Complementary Therapies
Heart Failure
Survival
Equipment and Supplies
Heart-Lung Transplantation
Equipment Design
Translational Medical Research
Resource Allocation
Genomics
Patient Selection
Renal Insufficiency
Cardiac Arrhythmias
Consensus
Decision Making
Randomized Controlled Trials
Public Health
Quality of Life
Databases
Guidelines

Keywords

  • Advanced heart failure
  • Destination therapy
  • Mechanical circulatory support device
  • Risk evaluation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation

Cite this

Destination therapy : An alternative for end-stage heart failure patients not eligible for heart transplantation. / Cadeiras, Martin; Von Bayern, Manuel Prinz; Pal, Amandeep; Asai, Tomohiro; Naka, Yoshifumi; Deng, Mario C.

In: Current Opinion in Organ Transplantation, Vol. 10, No. 4, 01.12.2005, p. 369-375.

Research output: Contribution to journalReview article

Cadeiras, Martin ; Von Bayern, Manuel Prinz ; Pal, Amandeep ; Asai, Tomohiro ; Naka, Yoshifumi ; Deng, Mario C. / Destination therapy : An alternative for end-stage heart failure patients not eligible for heart transplantation. In: Current Opinion in Organ Transplantation. 2005 ; Vol. 10, No. 4. pp. 369-375.
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