Transcatheter mitral valve intervention in advanced heart failure

Overcoming vulnerability in heart failure: Transitional tactical toughness

“…One haemodynamically‐guided management strategy using information from an implantable wireless pulmonary artery pressure sensor to direct treatment changes has shown promise and success in reducing heart failure hospitalization, particularly among patients who are moderately symptomatic (New York Heart Association class III) and who have previously been hospitalized with heart failure 9,10 . The third approach is one of invasive Laplace therapies that uses structural mechanical interventions to address mechanical cardiac perturbations by correcting cardiac physio‐anatomical abnormalities such as asynchronous contractility (via cardiac resynchronization therapy) or treating underlying functional valvular disease (mitral regurgitation), or if the disease advances inexorably, by evaluating patients for left ventricular assist device therapy or cardiac transplantation 5,11 . Such an approach is ideally implemented after rigorous efforts at employing disease‐modifying neurohormonal therapy have failed, coupled with evidence of intensified efforts for symptom control and emergence of hepato‐renal dysfunction 5 …”

“…or treating underlying functional valvular disease (mitral regurgitation), or if the disease advances inexorably, by evaluating patients for left ventricular assist device therapy or cardiac transplantation. 5,11 Such an approach is ideally implemented after rigorous efforts at employing disease-modifying neurohormonal therapy have failed, coupled with evidence of intensified efforts for symptom control and emergence of hepato-renal dysfunction. 5 In this issue of the Journal, the LeoDOR (Repetitive LevosimenDan infusions fOR patients with advanced chronic heart failure in the vulnerable post-discharge period) investigators tested the safety and efficacy of a haemodynamic intervention approach involving ambulatory cycles of levosimendan infusion within the vulnerable phase following decompensation or onset of advanced symptoms to treat heart failure.…”

Left Ventricular Assist Devices at the Crossroad of Innovation in Advanced Heart Failure

“…17 Clinicians must also recognize the particularly poor prognosis in 2 specific patient groups, which include those with moderate to severe secondary mitral regurgitation ineligible for a percutaneous mitral valve transcatheter edge-to-edge repair (or those implanted with a MitraClip who remain ill without improvement in heart failure) and nonresponders to cardiac resynchronization therapy. 17,18 All such patients should ideally be referred for management at centers specializing in advanced heart failure therapeutics.…”