Current Heart Failure Reports

, Volume 4, Issue 1, pp 43–47

Percutaneous mechanical devices in the management of decompensated heart failure

Article

Abstract

Heart failure is the only cardiovascular disease diagnosis increasing in prevalence in the United States. A number of drugs have been shown to reduce morbidity and mortality in patients with chronic heart failure. Despite these advances, the frequency of hospitalization for heart failure has continued to increase, and clinical trial data are lacking in demonstrable benefit of drug therapy for patients hospitalized with acute, decompensated heart failure. A number of percutaneous devices have been developed and are in various stages of investigation and use to improve symptoms and clinical outcomes in patients hospitalized with heart failure. These include “add-on” devices, such as continuous aortic flow augmentation and ultrafiltration devices, and “rescue” devices to be used in patients who are rapidly deteriorating despite medical therapy. In addition to the intra-aortic balloon pump, newer approaches include percutaneous ventricular assist devices that are available for short-term use to stabilize patients until recovery can occur or as “bridges” to longer-term assist or cardiac transplantation. In the coming years, expanded clinical investigation is likely to explore the potential for devices to normalize underlying cardiac function and thereby improve long-term clinical outcomes.

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References and Recommended Reading

  1. 1.
    American Heart Association: Heart Disease and Stroke Statistics: 2004 Update. Dallas: American Heart Association; 2004.Google Scholar
  2. 2.
    Levy D, Kenchaiah S, Larson MF, et al.: Long term trends in the incidence of and survival with heart failure. New Engl J Med 2002, 347:1397–1402.PubMedCrossRefGoogle Scholar
  3. 3.
    Berry C, Murdoch DR, McMurray JJ: Economics of chronic heart failure. Eur J Heart Fail 2001, 3:283–291.PubMedCrossRefGoogle Scholar
  4. 4.
    Cohn JN, Johnson G, Ziesche S, et al.: A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. N Engl J Med 1991, 325:303–310.PubMedCrossRefGoogle Scholar
  5. 5.
    Packer M, Bristow MR, Cohn JN, et al.: The effect of carvedilol on morbidity and mortality in patients with chronic heart failure: US Carvedilol Heart Failure Study Group. N Engl J Med 1996, 334:1349–1355.PubMedCrossRefGoogle Scholar
  6. 6.
    Packer M, Coats AJ, Fowler MB, et al.: Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001, 344:1651–1658.PubMedCrossRefGoogle Scholar
  7. 7.
    Pitt B, Remme W, Zannad F, et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003, 348:1309–1321.PubMedCrossRefGoogle Scholar
  8. 8.
    Costanzo MR: Ultrafiltration versus IV diuretics for patients hospitalized for acute decompensated congestive heart failure: a prospective randomized clinical trial: UNLOAD. Presented at the American College of Cardiology Annual Scientific Session. Atlanta, GA; March 11–14, 2006.Google Scholar
  9. 9.
    Haithcock BE, Morita H, Fanous NH, et al.: Hemodynamic unloading of the failing left ventricle using an arterial-to-arterial extracorporeal flow circuit. Ann Thorac Surg 2004, 77:158–163.PubMedCrossRefGoogle Scholar
  10. 10.
    Gharib M, Beizaie M: Correlation between negative near-wall shear stress in human aorta and various stages of congestive heart failure. Ann Biomed Eng 2003, 3:678–685.CrossRefGoogle Scholar
  11. 11.
    Schirger J, Chen H, Viole T, et al.: Renal actions of the Cancion® cardiac recovery system in severe experimental heart failure. Presented at the Heart Failure Society of America Annual Scientific Meeting. Toronto, Ontario; September 9–15, 2004.Google Scholar
  12. 12.
    Konstam MA, Czerska B, Bohm M, et al.: Continuous aortic flow augmentation: hemodynamic and renal responses to a novel percutaneous intervention in patients with decompensated heart failure. Circulation 2005, 112:3107–3114.PubMedCrossRefGoogle Scholar
  13. 13.
    Santa-Cruz RA, Cohen MG, Ohman EM: Aortic counterpulsation: a review of the hemodynamic effects and indications for use. Catheter Cardiovasc Interv 2006, 67:68–77.PubMedCrossRefGoogle Scholar
  14. 14.
    Thiele H, Lauer B, Hambrecht R, et al.: Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation 2001, 104:2917–2922.PubMedCrossRefGoogle Scholar
  15. 15.
    LaRocca GM, Shimbo D, Rodriguez CJ, et al.: The Impella Recover LP 5.0 left ventricular assist device: a bridge to coronary artery bypass grafting and cardiac transplantation. J Am Soc Echocardiogr 2006, 19:468.e5–468.e7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Jefferson Heart InstitutePhiladelphiaUSA

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