Left ventricular assist devices in patients with end-stage heart failure: suggestion of an alternative treatment based on clinically well-known concepts.
Encouraging results were obtained by using left ventricular assist devices (LVADs) in patients with end-stage heart failure (HF) that exhibits extremely high mortality and who were not candidates for heart transplantation. By using this so-called destination therapy (DT), a substantial percentage of these patients achieved sufficient improvement in cardiac function to permit the explantation of the device. The combination of mechanical and pharmacological therapy increased the frequency and durability of myocardial recovery as compared with other therapeutic approaches. Although cardiac transplantation, LVADs, and cardiac resynchronization therapy have provided a major advance in DT, their limitations stimulate the search for alternative therapies. We discuss the limitations of these 3 treatment options for end-stage HF. Also, we propose and discuss the possible advantages of a new intracorporeal procedure that works continuously as intraaortic balloon counterpulsation without an extracorporeal or intracorporeal computer-controlled mechanism.
Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain pfantidis@yahoo.es.
Panayotis
P
Fantidis
Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain.
Eladio
E
Sánchez
Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain.
Ibrahim
I
Tarhini
Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain.
Ijaz
I
Khan
Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain.
Tomas
T
Pineda
Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain.
Juan Antonio
JA
Corrales
Servicio de Cirugía Cardiovascular, Hospital Universitario Infanta Cristina, Avenida de Elvas, Badajoz, Spain.
José Ramón
JR
González
D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000379:methods; D018579:Patient Selection; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000628:therapy*
alternative therapy; complications; destination therapy; end-stage heart failure; intraaortic balloon counterpulsation-like mechanism