4 Bridges to transplant

Heart transplantation remains the gold standard treatment for end-stage heart failure. By definition, these patients are unwell, and unfortunately a proportion will die waiting for transplant. The journey to transplantation is usually characterised by recurrent hospitalisations and may be complicated by progressive organ dysfunction. Optimisation of patient outcomes involves upward titration of evidence-based therapy (Ponikowski, et al. 2016), however, in this cohort treatment is often gradually withdrawn due to patient hypotension, renal dysfunction or other organ failure (Baumwol, 2017). Intermittent diuretic therapy has been suggested, with limited evidence of long-term benefit. Short-term mechanical support with intra-aortic balloon pumping or extra-corporeal membrane oxygenation allows stabilisation in cardiogenic shock, but is often of insufficient duration to bridge to successful transplantation without complication. Newer less invasive devices may be associated with fewer complications, but have not been shown to be more durable at this point. Chronic mechanical supports, as afforded by left ventricular assist or total artificial heart devices, offer a durable solution and have been shown to improve survival as well as symptoms in end-stage heart failure patients (Aaronson, et al. 2012; Starling, et al. 2011). The success of smaller continuous flow LVADs, especially, has increased the number of patients being supported on device waiting for heart transplantation and s...
Source: Heart Asia - Category: Cardiology Authors: Tags: APAHFF Abstracts 2017 Source Type: research