J Korean Med Assoc.  2008 Apr;51(4):306-316. 10.5124/jkma.2008.51.4.306.

Treatment of Medically Intractable End-Stage Heart Failure

• Choi JH
• Jun ES

• KMID: 2185739
• DOI: http://doi.org/10.5124/jkma.2008.51.4.306

Abstract

Heart failure is the final pathway for myriad diseases that affect the heart. Patients with refractory symptoms of heart failure despite ultimate medical therapy have very poor prognosis. In these patients, replacement of failing heart with permanent organ transplantation or ventricular assist device, which is temporarily or permanently implanted, is often life-saving and can improve long term prognosis. Cardiac transplantation is the established standard for the treatment of end-stage cardiac disease refractory to medical therapy. The clinical success of transplantation has been streadily improving with the refinement of recipient selection, better donor management, and better immunosuppressive agents. Recent substantial evolution of mechanical circulatory assist devices improved dramatically the outcome of not only patients in decompensated heart failure but also a large proportion of acute heart failure patients in cardiogenic shock. With this evolution, implantable sophisticated devices are being used as destination therapy as a substitute for transplantation and are expected to diminish the intrinsic shortage of donor compared to the epidemic of heart failure.

Keyword

End-stage heart failure; Heart transplantation; Mechanical assist device

MeSH Terms

Heart
Heart Diseases
Heart Failure
Heart Transplantation
Heart-Assist Devices
Humans
Immunosuppressive Agents
Organ Transplantation
Prognosis
Shock, Cardiogenic
Tissue Donors
Transplants
Immunosuppressive Agents

Figure

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  Figure 1 Survival rates of heart failure (Adapted from Levy, N Engl J Med 2002; 347: 1397-1402).

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  Figure 2 Diagram of percutaneous cardiopulmonary support system (PCPS; EBS Capiox, Terumo, Japan).

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  Figure 3 Diagrams of ventricular assist device (A: Impella (Abiomed, USA), B: BiVAD, C: implantable continuous flow pump)(Adapted from Miller, New Engl J Med 2007: 357; 9: 885-896).

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  Figure 4 Scheme for selection of patients with acute cardiac disease or congestive heart failure for implantation of left ventricular assist devices (adapted from Rose, et al. N Engl J Med 2001; 345: 1435-1443).

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