Ventricular Assist Device – How to Obtain Optimal Benefits?

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Book Chapter

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Heart failure is now acknowledged to be the most common malignant disease in industrialized countries, with advanced heart failure having a worse prognosis than most forms of cancer (Garg, Yusuf 1993). Advances in pharmacological treatment have helped patients in all stages of systolic dysfunction, even those with NYHA IV symptoms (the Captopril-Digoxin Multicenter Research Group 1988, Packer et al. 1996, the RALES Investigators 1996). The Working Group on Heart Failure of the European Society of Cardiology has promoted a number of initiatives aimed at improving the treatment of heart failure (ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008).

Despite advances in pharmacological treatments aimed at a neurohormonal blockade for heart failure, there is still a growing number of patients with advanced symptoms who suffer significant morbidity and mortality. Mechanical stresses on the myocardium (increased preload and afterload) and chronic neurohormonal activation conspire to propagate the maladaptive ventricular remodeling responsible for the insidious nature of heart failure. Recent studies suggest that further pharmacological neurohormonal blockade may be neither safe nor effective (Mann 2004). This finding has led to the concept that the limit to which neurohormonal and cytokine mechanisms can be blocked in heart failure patients has already been reached (Cohn, Tognoni 2001). The problem of how to treat patients worldwide who develop advanced heart failure despite optimal medical therapy has not yet been resolved (Gronda, Vitali 1999).


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