Surgical methods of treatment of chronic heart failure and their place in modern clinical recommendations

2020 ◽  
Vol 22 (4) ◽  
pp. 183-191
Author(s):  
O. T. Kotsoeva ◽  
A. V. Koltsov ◽  
V. V. Tyrenko ◽  
A. A. Ialovets
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Surgical Methods ◽  
The Moment

This review discusses a number of aspects of surgical methods for treating severe chronic heart failure: resynchronizing therapy, mechanical circulatory support systems, and heart transplantation. Surgical methods for the treatment of heart failure are a rapidly developing field of modern cardiology and cardiac surgery. The main surgical method of treatment was and remains orthotopic transplantation of a donor heart. The advent of implantable systems has affected the problem of heart transplantation. Over the past decade, the use of mechanical circulatory support systems has grown significantly. At the moment, there are 3 main directions: creating devices for auxiliary blood circulation, various modes and methods of electrical stimulation of the myocardium, creating devices that mechanically remodel the heart chambers (left ventricle). All of these directions to some extent (depending on the evidence base) have found their place in modern recommendations for the treatment of chronic heart failure. The use of mechanical left ventricular remodeling shows good results in patients suffering from symptomatic heart failure, which leads to a significant and persistent decrease in the volume of the left ventricle and improvement of its function, symptoms and quality of life. Despite the fact that at the moment the geography and prevalence of their use is small, the number of implanted devices will only grow. Thus, given the need for frequent hospitalizations and high treatment costs, it is necessary to improve modern methods of surgical treatment of severe and terminal heart failure, make them more accessible, which will affect the duration and quality of life of these patients.

scholarly journals SUPPORTING DEVICES IN THE TREATMENT OF CHRONIC HEART FAILURE IN ELDERLY AND OLD PATIENTS

2020 ◽  
Vol 2 (3) ◽  
pp. 40-57
Author(s):  
Gennadiy Hubulava ◽  
Kirill L. Kozlov ◽  
Andrey N. Bogomolov ◽  
Aleksey Volkov ◽  
Viktor N. Fedorets ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Clinical Practice ◽  
Chronic Heart Failure ◽  
Severe Heart Failure ◽  
Circulatory Support ◽  
Old Patients ◽  
Western Countries ◽  
Surgical Methods

Chronic heart failure (CHF) is a widespread disease associated with high rates of disability and mortality, as well as a decrease in the quality of life. Moreover, the vast majority of patients are elderly and senile. Modern surgical methods of treating heart failure are able to increase the duration and quality of life of such patients, however, the need far exceeds the volume of this care, and some highly effective methods common in Western countries are still not used in Russian clinical practice. Elderly age is a risk factor for the development of senile asthenia (frailty) and concomitant pathology. Large abdominal surgery is often contraindicated for patients with signs of senile asthenia, and the method of choice in patients with severe heart failure is the implantation of devices for long-term mechanical circulatory support (LT-MCS). After implantation of LT-MCS, a regression of signs of senile asthenia may be observed. The topic of an integrated approach to non-drug treatment of heart failure in elderly and senile patients in Russia has not been studied enough. In particular, the implantation of LT-MCS is not used in Russian clinical practice, while in many Western countries for many years it has been the main and most effective treatment for severe heart failure. Systematization of the available up-to-date information on this topic could help increase the duration and quality of life of patients with severe heart failure.

scholarly journals Overall quality of life improves to similar levels after mechanical circulatory support regardless of severity of heart failure before implantation

2014 ◽  
Vol 33 (4) ◽  
pp. 412-421 ◽  
Author(s):  
Kathleen L. Grady ◽  
David Naftel ◽  
Lynne Stevenson ◽  
Mary Amanda Dew ◽  
Gerdi Weidner ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Circulatory Support

Acute heart failure: heart failure surgery and transplantation

2018 ◽  
Author(s):  
Aikaterini N Visouli ◽  
Antonis A Pitsis
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Heart Transplantation ◽  
Acute Heart Failure ◽  
Mechanical Circulatory Support ◽  
Circulatory Support

Cardiac surgery should be considered in all cases of acute heart failure (AHF) or acutely decompensated chronic heart failure (ADCHF) caused, precipitated, or aggravated by surgically correctable causes. Mechanical circulatory support (MCS) and heart transplantation (HTx) may be considered when all conventional measures have failed.

Acute heart failure: heart failure surgery and transplantation

2017 ◽  
Author(s):  
Aikaterini N Visouli ◽  
Antonis A Pitsis
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Chronic Heart Failure ◽  
Heart Transplantation ◽  
Acute Heart Failure ◽  
Mechanical Circulatory Support ◽  
Circulatory Support

Cardiac surgery should be considered in all cases of acute heart failure (AHF) or acutely decompensated chronic heart failure (ADCHF) caused, precipitated, or aggravated by surgically correctable causes. Mechanical circulatory support (MCS) and heart transplantation (HTx) may be considered when all conventional measures have failed.

Heart Transplantation - Part I: General Considerations

2020 ◽  
Author(s):  
Michael M. Givertz
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Heart Disease ◽  
Heart Transplantation ◽  
Structural Heart Disease ◽  
Poor Quality ◽  
Disease Stage ◽  
Circulatory Support ◽  
Stage D

Heart failure (HF) is a major public health problem with significant associated morbidity and mortality. In 2001, the American College of Cardiology/American Heart Association (ACC/AHA) guideline committee proposed a new approach to the classification of HF that emphasized both the development and progression of disease.  Stage A and B patients are at high risk for developing HF, and include those without structural heart disease (Stage A) and those with structural heart disease, but without signs or symptoms of HF (Stage B).  Stage C and D patients have structural heart disease with prior or current symptoms of HF (Stage C) or refractory HF requiring specialized interventions (Stage D).  Rregistries suggest that between 5% and 10% of patients with HF have advanced disease, which is associated with 1-year mortality in excess of 50% and a poor quality of life. The Heart Failure Society of America (HFSA) defines Stage D heart failure as “the presence of progressive and/or persistent severe signs and symptoms of heart failure despite optimized medical, surgical, and device therapy…generally accompanied by frequent hospitalization, severely limited exertional tolerance, and poor quality of life.”  In this two-part chapter, we focus on heart transplantation, which remains the standard-of-care for highly selected patients with end-stage HF and absence of contraindications to transplant.1-5 This review contains 7 figures, 8 tables, and 46 references. Key words: heart failure, cardiomyopathy, heart transplant, mechanical circulatory support, prognosis, pulmonary hypertension, diabetes, HLA sensitization, donor

scholarly journals Exercise‐Based Cardiac Rehabilitation with and without Neuromuscular Electrical Stimulation and its Effect on Exercise Tolerance and Life Quality of Persons with Chronic Heart Failure

2018 ◽  
Vol 65 (1) ◽  
pp. 151-164
Author(s):  
Cezary Kucio ◽  
Petr Stastny ◽  
Bożena Leszczyńska-Bolewska ◽  
Małgorzata Engelmann ◽  
Ewa Kucio ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Electrical Stimulation ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Lower Extremity ◽  
Cardiac Rehabilitation ◽  
Exercise Tolerance ◽  
Neuromuscular Electrical Stimulation

Abstract The study compares the effect of an exercise-based cardiac rehabilitation program with a program combining physical exercise and lower extremity neuromuscular electrical stimulation (NMES) on the recovery of patients with chronic heart failure (CHF) with NYHA II-III symptoms. Seventy two patients with stable CHF were randomly distributed to four groups that received exercise-based cardiac rehabilitation and pharmacological treatment. Groups I and II were additionally administered NMES (35 Hz and 10 Hz, respectively) and in Group III sham NMES was applied. Group IV (controls) received solely pharmacological and exercise treatment. Exercise tolerance and quality of life were assessed in patients pre-treatment and at week 3. Three weeks of rehabilitation induced significant increases (p < 0.05) in the distance covered in the 6-minute walk test, the metabolic equivalent (MET), the duration of the treadmill exercise stress test, the left ventricle ejection fraction (LVEF) and improved quality of life in all groups, but between-group differences were not significant (p > 0.05). In none of the groups were the left ventricle end-systolic and end-diastolic diameters (mm) measured at week 3 significantly different from their baseline values (p > 0.05). Exercise-based cardiac rehabilitation contributed to higher exercise tolerance, LVEF and quality of life of CHF patients (NYHA II-III), contrary to cardiac rehabilitation combined with lower extremity NMES (35 Hz and 10 Hz) that failed to induce such improvements. More research is necessary to assess the therapeutic efficacy of NMES applied to CHF patients with NYHA IV symptoms.

P771Metoprolol succinate efficacy in patients with chronic heart failure on the background of obesity: genetic aspects of individual sensitivity and tolerability

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Gasanov ◽  
O Medentseva ◽  
I Rudyk ◽  
V Galchinskaya
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Heart Rate ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Control Group ◽  
Individual Sensitivity ◽  
Cyp2d6 Gene ◽  
Metoprolol Succinate

Abstract Background The cornerstone of modern cardiology is the problem of comorbidity, the combination of chronic heart failure (CHF) with obesity as well. Efficacy of treatment with beta-blockers in different patients varies significantly, partly depending on genotypically determined features of its metabolization with enzymes. Purpose To improve the CHF treatment with metoprolol succinate efficacy in patients with obesity by detection of genetic aspects of individual sensitivity and tolerability. Methods A prospective randomized dynamic (1 year) study was conducted involving 127 patients with CHF II–III stages at the age of 32–87 years; they were distributed into main group with combination of CHF and obesity (73 patients) and control group with only CHF (54 patients). The examination included an assessment of CYP2D6 gene 1846G/A polymorphism, clinical symptoms, quality of life (by Minnesota questionnaire), 6-minute walk test data, doppler echocardiography, heart rate variability, serum insulin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Metoprolol succinate was administered according to a standard regimen with dose titration every 2 weeks from 12.5 to 100–200 mg. The critical p-level was 0.05. Results An association of “unfavorable” allele A with an increase in body weight was found (p=0.05). As a result of treatment, better indicators of the clinical status were found in control group (6 [5; 7] versus 7 [6; 8] points in obese patients, p=0.05) and quality of life in patients with genotype GG than the GA genotype (p<0,05). The use of metoprolol succinate in patients with GG genotype is associated with more pronounced positive dynamics of treatment efficacy. In contrast to the carriers of the GA genotype, in patients with the GG genotype there were an increase in left ventricle ejection fraction (by 21.5% versus 9.3%, p<0.01) and the reduction of the left ventricle end-diastolic size (p=0.02). The GG genotype carriers significantly increased the amount of exercise tolerance (p<0.05), and showed a more pronounced improvement in quality of life (p<0.03) and the clinical state (p=0.05), as well as the normalization of the vegetative balance (LF/HF index). The level of serum NT-proBNP in the GG genotype was lower than in patients with GA genotype (p=0.05). At the same time, patients with a GA genotype showed a more pronounced decrease in heart rate compared to those with a GG genotype (p<0.05). In carriers of the GA genotype, a tendency to a greater incidence of side effects compared with the GG genotype (bradycardia 42.0% vs. 28.0%, p<0,05; cold extremities 44.0% vs. 32.0%, p<0.05, fatigue 39.0% vs. 31.0%, p<0.05, headache 32.0% vs. 24.0%, p<0,10, drowsiness 38,0% vs. 27,0%, p<0,05). Conclusions It is useful to take into account the CYP2D6 gene 1846G/A polymorphism in order to improve the CHF treatment with metoprolol succinate in patients with obesity.

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