LONG-TERM management of end-stage heart failure

Publication date: Available online 18 July 2017 Source:Best Practice & Research Clinical Anaesthesiology Author(s): Marlena V. Habal, A. Reshad Garan End-stage heart failure manifests as severe and often relentless symptoms that define the clinical syndrome of heart failure, namely congestion and hypoperfusion. These patients suffer from dyspnea, fatigue, abdominal discomfort and ultimately cardiac cachexia. Renal and hepatic dysfunction frequently further complicate the process. Recurrent hospitalizations, cardiac arrhythmias, and intolerance to standard heart failure therapies are common as the disease progresses. Management focuses on controlling symptoms, correcting precipitants, avoiding triggers, and maximizing therapies with demonstrable survival benefit. Amongst appropriate candidates, advanced therapies such as orthotopic heart transplant (OHT) can significantly extend survival and improve quality-of-life. Left ventricular assist devices (LVADs) have been used with increasing frequency as a bridge to OHT or as destination therapy in appropriately selected candidates where they have a demonstrable mortality benefit over medical therapy. Importantly, a multidisciplinary patient-centred approach is crucial when considering these advanced therapies.

Source: Best Practice and Research Clinical Anaesthesiology - July 18, 2017 Category: Anesthesiology Source Type: research