Management of Stage D Heart Failure

Chapter
Part of the Clinical Cases in Cardiology book series (CCC)

Abstract

A 62 year old male with hypertension, hyperlipidemia, and ischemic cardiomyopathy with a left ventricular ejection fraction of 25% and a left ventricular end-diastolic dimension of 7 cm presented with 2 weeks of progressive weight gain, orthopnea, paroxysmal nocturnal dyspnea (PND), and dyspnea on exertion. Recent dose increase of outpatient diuretics did not provide relief of his symptoms. He was dyspneic with activities of daily living, had a poor appetite, and was frequently fatigued with occasional lightheadedness. He had no chest pain, palpitations or any other acute illnesses. He was adherent to medications, which included carvedilol, lisinopril, spironolactone, and torsemide. He underwent cardiac resynchronization therapy and defibrillator placement 2 years ago. This was his third admission to the hospital in the preceding 6 months.

Keywords

Heart transplantation Heart assist devices 

References

  1. 1.
    Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, PE MB, JJ MM, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL, American College of Cardiology Foundation, American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147–239.CrossRefPubMedGoogle Scholar
  2. 2.
    Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Meier P, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier OH, Desvigne-Nickens P, Oz MC, Poirier VL, Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure Study Group. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345:1435–43.CrossRefPubMedGoogle Scholar
  3. 3.
    Lund LH, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Goldfarb S, Levvey BJ, Meiser B, Rossano JW, Yusen RD, Stehlik J. The registry of the international society for heart and lung transplantation: thirty-second official adult heart transplantation report--2015; focus theme: early graft failure. J Heart Lung Transplant. 2015;34:1244–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation. 1991;83:778–86.CrossRefPubMedGoogle Scholar
  5. 5.
    Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, Danziger-Isakov L, Kirklin JK, Kirk R, Kushwaha SS, Lund LH, Potena L, Ross HJ, Taylor DO, Verschuuren EA, Zuckermann A, International Society for Heart Lung Transplantation (ISHLT) Infectious Diseases Council, International Society for Heart Lung Transplantation (ISHLT) Pediatric Transplantation Council, International Society for Heart Lung Transplantation (ISHLT) Heart Failure and Transplantation Council. The 2016 international society for heart lung transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant. 2016;35:1–23.CrossRefPubMedGoogle Scholar
  6. 6.
    Peterson LR, Schechtman KB, Ewald GA, Geltman EM, de las Fuentes L, Meyer T, Krekeler P, Moore ML, Rogers JG. Timing of cardiac transplantation in patients with heart failure receiving beta-adrenergic blockers. J Heart Lung Transplant. 2003;22:1141–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Peura JL, Colvin-Adams M, Francis GS, Grady KL, Hoffman TM, Jessup M, John R, Kiernan MS, Mitchell JE, O’Connell JB, Pagani FD, Petty M, Ravichandran P, Rogers JG, Semigran MJ, Toole JM, American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Disease in the Young, Council on Cardiovascular Nursing, Council on Cardiovascular Radiology and Intervention, Council on Cardiovascular Surgery and Anesthesia. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012;126:2648–67.CrossRefPubMedGoogle Scholar
  8. 8.
    Stevenson LW, Pagani FD, Young JB, Jessup M, Miller L, Kormos RL, Naftel DC, Ulisney K, Desvigne-Nickens P, Kirklin JK. Intermacs profiles of advanced heart failure: the current picture. J Heart Lung Transplant. 2009;28:535–41.CrossRefPubMedGoogle Scholar
  9. 9.
    Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, Massey T, Milano CA, Moazami N, Sundareswaran KS, Farrar DJ, HeartMate II Clinical Investigators. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139:1316–24.CrossRefPubMedGoogle Scholar
  10. 10.
    Slaughter MS, Pagani FD, Rogers JG, Miller LW, Sun B, Russell SD, Starling RC, Chen L, Boyle AJ, Chillcott S, Adamson RM, Blood MS, Camacho MT, Idrissi KA, Petty M, Sobieski M, Wright S, Myers TJ, Farrar DJ, HeartMate II Clinical Investigators. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant. 2010;29:S1–39.CrossRefPubMedGoogle Scholar
  11. 11.
    Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol. 2008;51:2163–72.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Miller LW, Pagani FD, Russell SD, John R, Boyle AJ, Aaronson KD, Conte JV, Naka Y, Mancini D, Delgado RM, MacGillivray TE, Farrar DJ, Frazier OH, HeartMate IICI. Use of a continuous-flow device in patients awaiting heart transplantation. N Engl J Med. 2007;357:885–96.CrossRefPubMedGoogle Scholar
  13. 13.
    Aaronson KD, Slaughter MS, Miller LW, McGee EC, Cotts WG, Acker MA, Jessup ML, Gregoric ID, Loyalka P, Frazier OH, Jeevanandam V, Anderson AS, Kormos RL, Teuteberg JJ, Levy WC, Naftel DC, Bittman RM, Pagani FD, Hathaway DR, Boyce SW, HeartWare Ventricular Assist Device Bridge to Transplant ADVANCE Trial Investigators. Use of an intrapericardial, continuous-flow, centrifugal pump in patients awaiting heart transplantation. Circulation. 2012;125:3191–200.CrossRefPubMedGoogle Scholar
  14. 14.
    Kirklin JK, Naftel DC, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, Miller MA, Baldwin JT, Young JB. Seventh intermacs annual report: 15,000 patients and counting. J Heart Lung Transplant. 2015;34:1495–504.CrossRefPubMedGoogle Scholar
  15. 15.
    Wever-Pinzon O, Drakos SG, Kfoury AG, Nativi JN, Gilbert EM, Everitt M, Alharethi R, Brunisholz K, Bader FM, Li DY, Selzman CH, Stehlik J. Morbidity and mortality in heart transplant candidates supported with mechanical circulatory support: is reappraisal of the current united network for organ sharing thoracic organ allocation policy justified? Circulation. 2013;127:452–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Dang NC, Topkara VK, Mercando M, Kay J, Kruger KH, Aboodi MS, Oz MC, Naka Y. Right heart failure after left ventricular assist device implantation in patients with chronic congestive heart failure. J Heart Lung Transplant. 2006;25:1–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Patel ND, Weiss ES, Schaffer J, Ullrich SL, Rivard DC, Shah AS, Russell SD, Conte JV. Right heart dysfunction after left ventricular assist device implantation: a comparison of the pulsatile HeartMate I and axial-flow HeartMate II devices. Ann Thorac Surg. 2008;86:832–40. discussion 832-840CrossRefPubMedGoogle Scholar
  18. 18.
    Baumwol J, Macdonald PS, Keogh AM, Kotlyar E, Spratt P, Jansz P, Hayward CS. Right heart failure and “failure to thrive” after left ventricular assist device: clinical predictors and outcomes. J Heart Lung Transplant. 2011;30:888–95.PubMedGoogle Scholar
  19. 19.
    Akhter SA, Badami A, Murray M, Kohmoto T, Lozonschi L, Osaki S, Lushaj EB. Hospital readmissions after continuous-flow left ventricular assist device implantation: incidence, causes, and cost analysis. Ann Thorac Surg. 2015;100:884–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Stulak JM, Davis ME, Haglund N, Dunlay S, Cowger J, Shah P, Pagani FD, Aaronson KD, Maltais S. Adverse events in contemporary continuous-flow left ventricular assist devices: a multi-institutional comparison shows significant differences. J Thorac Cardiovasc Surg. 2016;151:177–89.CrossRefPubMedGoogle Scholar
  21. 21.
    Deo SV, Sharma V, Cho YH, Shah IK, Park SJ. De novo aortic insufficiency during long-term support on a left ventricular assist device: a systematic review and meta-analysis. ASAIO J. 2014;60:183–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Harvey L, Holley C, Roy SS, Eckman P, Cogswell R, Liao K, John R. Stroke after left ventricular assist device implantation: outcomes in the continuous-flow era. Ann Thorac Surg. 2015;100:535–41.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Beth Israel Deaconess Medical CenterBostonUSA

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