Mechanical Circulatory Assistance - An Evolving Therapy -

Fitzpatrick, J. Raymond; Woo, Y. Joseph

doi:10.1253/circj.cj-10-1091

Cited by 10 publications

(9 citation statements)

References 37 publications

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“…Globally, LV assistance device (LVAD) has been successfully used in the clinical field since the 1970 s. 21, 22 In Korea, however, although LVAD was first introduced in 2008, the LVAD system has been used very little, because LVAD is not covered by insurance, whereas HTPL is fully covered. Therefore, nearly all status 0 cases belong to the 'mechanical ventilator with extra-corporeal membrane oxygenation (ECMO)' category.…”

Section: Discussionmentioning

confidence: 99%

Under-Utilization of Donor Hearts in the Initial Era of the Heart Transplant Program in Korea

Cha

Lee

Cho

et al. 2013

Circ J

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Section: Discussionmentioning

confidence: 99%

Under-Utilization of Donor Hearts in the Initial Era of the Heart Transplant Program in Korea

Cha

Lee

Cho

et al. 2013

Circ J

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“…41 Patients unresponsive to medical therapy may require additional mechanical circulatory support. 42 Discussion of mechanical support devices in AHF is beyond the scope of this review.…”

Section: Treatment Of the "Cold" Patientmentioning

confidence: 99%

Hemodynamic Classifications of Acute Heart Failure and Their Clinical Application - An Update -

Thomas

Nohria

2012

Circ J

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Acute heart failure (AHF) is classically defined by signs and symptoms related to elevated ventricular filling pressures. Regardless of precipitant, underlying etiology or ejection fraction, the vast majority of hospital admissions are the result of worsening chronic HF. For the acutely decompensated patient, 4 hemodynamic profiles, stratified by degree of congestion ("dry" or "wet") and adequacy of perfusion ("warm" or "cold") predict prognosis and guide therapy. Relief of congestion is the primary goal of AHF management. Loop diuretics remain the mainstay of AHF treatment, but new modalities such as veno-venous ultrafiltration are promising. For patients with evidence of hypoperfusion, vasoactive agents may be needed to facilitate diuresis. The decision to use vasodilators or inotropes is complex and the need for invasive hemodynamic monitoring is often determined by the individual patient's characteristics. Routine use of inotropes should be discouraged; however when used, the short-term hemodynamic benefits conferred by these agents must be balanced against their tendency to increase adverse events. Although these strategies are effective in alleviating symptoms in most patients, management dilemmas arise from cardiorenal interactions and limitations in effective novel therapies. Epidemiological studies continue to emphasize that AHF portends a poor prognosis. Further studies are needed to improve our understanding and outcomes in this growing patient population. (Circ J 2012; 76: 278 - 286)

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“…Daniels postulates that if a patient is facing a life-and-death situation and there is a reasonable means of intervention to alter that course, then the goals of medicine tend to promote utilizing those means [8, 9]. This is challenging for the sickest patient as DT outcomes are inferior with worse INTERMACS profiles, or if a patient's medical condition cannot be optimized prior to DT [7, 10]. …”

Section: Caring For the Sickest Of The Sickmentioning

confidence: 99%

Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

Swetz

Stulak

Dunlay

et al. 2012

Cardiology Research and Practice

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Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS). Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT) for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL) and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.

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Mechanical Circulatory Assistance - An Evolving Therapy -

Cited by 10 publications

References 37 publications

Under-Utilization of Donor Hearts in the Initial Era of the Heart Transplant Program in Korea

Under-Utilization of Donor Hearts in the Initial Era of the Heart Transplant Program in Korea

Hemodynamic Classifications of Acute Heart Failure and Their Clinical Application - An Update -

Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

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