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Surgical treatment of heart failure — A changing paradigm?

Chirurgische Behandlung der terminalen Herzinsuffizienz — ein sich änderndes Paradigma?

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Summary

Background: End-stage heart failure treatment remains the field of transplant surgery. Despite tremendous results and steadily increasing quality of life and survival, the lack of donor organs and their increasing shortage over the last few years is relativizing the efforts made for the patients.

Methods and Results: A lot of projects for alternatives, originating from bridging methods, are under investigation and in progress. Besides different mechanical support devices (left-ventricular assist devices) there are also electrical (implantable cardioverter defibrillators, multisite) and biomechanical devices (cardiomyoplasty) offered. Furthermore, ventricular geometry shaping is a form of support (Batista, Acorn).

Conclusions: Really new and exciting approaches are on the surgical horizon with cellular cardiomyoplasty (stem-cell transplantation, foetal cardiomyocytes, skeletal myocyte transplantation, cytokine stimulation for immigration of stem cells to the heart).

Zusammenfassung

Grundlagen: Die Behandlung des Endstadiums einer Herzerkrankung bleibt im chirurgischen Bereich das Feld der Transplantation. Trotz großartiger Erfolge und ständig steigender Lebensqualität von Transplantierten mit gleichzeitig immer besserem Überleben, ist der Mangel an Spenderorganen während der letzten Jahre der relativierende Faktor.

Methodik und Ergebnisse: Daher gibt es eine Reihe von Alternativen und Projekten, die aus der Vergangenheit, aus den Bridging-Methoden zur Transplantation entstanden und derzeit in Entwicklung sind. Neben verschiedenen mechanischen Unterstützungspumpen (LVAD) gibt es auch elektrische (ICD, Multisite) und biomechanische Möglichkeiten (Kardiomyoplastie). Darüber hinaus wird auch die Modellierung der Ventrikelgeometrie als eine Form der Unterstützung (Batista, Acorn) untersucht.

Schlußfolgerungen: Wirklich neue und aufregende Ansätze gibt es im Bereich der zullulären Cardiomyoplastie (Stammzelltransplantation, fetale Kardiomyozyten, Skelettmuskeltransplantation und Zytokinstimulation zum Einwandern von Stammzellen in das Herz).

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  1. Division of Transplantation Surgery, Department of Surgery, Karl-Franzens-University, Auenbruggerplatz 29, A-8036, Graz

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Tscheliessnigg, K.H. Surgical treatment of heart failure — A changing paradigm?. Eur. Surg. 34, 347–353 (2002). https://doi.org/10.1046/j.1563-2563.2002.02083.x

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