Mechanical Approach in the Management of Advanced Acute and Chronic Heart Failure

Abstract

Despite the progress in medical therapy, advanced heart failure (AHF) remains a global epidemic with high morbidity and mortality. Novel cardiac support strategies such as pharmacologic agents, mechanical circulatory support (MCS), and cell- or matrix-based therapies are promising for these patients. The indications, types, and timing of MCS implantation depend to a large extent on the presentation, clinical status of the patient, underlying etiology, and long-term prospects. The presence or absence of end-organ damage has a significant impact on prognosis following MCS initiation. Although many patients with acute AHF may have end-organ damage, their prospect of recovery, once appropriate therapy is instituted, is better than for patients who had AHF for longer periods of time. We consider the multidisciplinary approaches used for the management of AHF and the novel cardiac support strategies (eg, MCS). Appropriate selection of patient, device, time, and end point is essential for better outcomes.

Congestive Heart Failure With Apparently Preserved Left Ventricular Systolic Function

“…[1][2][3] Despite recent advances in therapy and devices, congestive heart failure (CHF) carries high rates of mortality once clinically manifested. 4 Moreover, irrespective of etiology, CHF is associated with poor outcome and sudden death. [4][5][6] The pathophysiology of HFPEF is different from that of HF with reduced left ventricular ejection fraction (LVEF) and is characterized by impaired relaxation of the myocardium and left ventricular stiffness.…”

“…4 Moreover, irrespective of etiology, CHF is associated with poor outcome and sudden death. [4][5][6] The pathophysiology of HFPEF is different from that of HF with reduced left ventricular ejection fraction (LVEF) and is characterized by impaired relaxation of the myocardium and left ventricular stiffness. 5,6 The reported incidence of patients with HFPEF varied from 40% to 71% (average: 54%) among all cases with HF.…”