Encouraging results were obtained by using left ventricular assist devices (LVADs) in patients with end-stage heart failure (HF) that exhibits extremely high mortality and who were not candidates for heart transplantation. By using this so-called destination therapy (DT), a substantial percentage of these patients achieved sufficient improvement in cardiac function to permit the explantation of the device. The combination of mechanical and pharmacological therapy increased the frequency and durability of myocardial recovery as compared with other therapeutic approaches. Although cardiac transplantation, LVADs, and cardiac resynchronization therapy have provided a major advance in DT, their limitations stimulate the search for alternative therapies. We discuss the limitations of these 3 treatment options for end-stage HF. Also, we propose and discuss the possible advantages of a new intracorporeal procedure that works continuously as intraaortic balloon counterpulsation without an extracorporeal or intracorporeal computer-controlled mechanism.
RosamondWFlegalKFridayG. Heart disease and stroke statistics—2007 update: a report from the American heart association statistics committee and stroke statistics subcommittee. Circulation. 2007;115(5):e69–e71.
2.
RogerVLGoASLloyd JonesDM. Heart disease and stroke statistics: 2012 update. a recent report from the American heart association. Circulation. 2012;125(1):e2–e220.
3.
MosterdAHoesAW. Clinical epidemiology of heart failure. Heart. 2007;93(9)1137–1146.
4.
Lloyd JonesDMLarsonMGLeipEP. Framingham heart study. lifetime risk for developing congestive heart failure. the Framingham heart study. Circulation. 2002;106;(24):3068-3072.
5.
The Heart Outcomes Prevention Evaluation Study Investigators. Effects of angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342 (3):145–153.
6.
PackerMCoatsAJFowlerMB. Effect of carvedilol on survival in severe chronic failure. N Engl J Med. 2001;344(22):1651–1658.
7.
Poole WilsonPSwedbergKClelandJG. Carvedilol or Metoprolol European Trial Investigators. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the carvedilol Or metoprolol European Trial (COMET); randomised controlled trial. Lancet. 2003;362(9377):7–13.
8.
ZannadFMcMurrayJJKrumH. EMPHASIS-HF Study Group. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364(6):11–21.
9.
CohnJNTognoniG. For the vasaltran heart failure trial investigators. a randomised trial of the angiotensin-receptor blocker valsatran in chronic heart failure. N Engl J Med. 2001;345(23):1667–1675.
10.
AbrahamWTSmithSA. Devices in the management of advanced, chronic heart failure. Nat Rev Cardiol. 2013;10(2):98–110.
11.
StehilkJEdwardsLBKucheryavayaAY. The registry of the international Society for heart and lung transplantation: twenty-eighth adult heart transplant report-2011. Nat Rev Cardiol. 2013;10 (2):98–1094.
12.
CostanzoMNaftelDPritzkerM. Heart transplant coronary artery disease detected by coronary angiography: A multiinstitutional study of preoperative donor and recipient risk factors. J Heart LungTransplant. 1998;17(8):744–753.
13.
LabarrereCNelsonDCoxCPittsDKirlinPHalbrookH. Cardiac-specific troponin I levels and risk of coronary artery disease and graft failure following heart transplantation. JAMA. 2000;284(4):457–464.
14.
AlmenarLDelgadoJCrespoMSegoviaJ. Situación actual del trasplante cardiaco en España. Rev Esp Cardiol. 2010;63 (suppl 1):132–149.
15.
AroraSAndreassenASimonsenS. Prognostic Importance of renal function 1 year after heart transplantation for all-cause and cardiac mortality and development of allograftvasculopathy. Transplantation. 2007;84(2):149–154.
16.
CantarovichMHirshaAAlamaA. The Clinical impact of an early decline in kidney function in patients following heart transplantation. Am J Transplant. 2009;9(2):348–354.
17.
OjoA. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol. 2007;27(4):498–507.
18.
AlamABadovinacKIvisFTrpeskiLCantarovichM. The outcome of heart transplant recipients following the development of end-stage renal disease: analysis of the Canadian Organ Replacement Register (CORR). Am JTransplant. 2007;7(2):461–465.
19.
BelletMCabrolCSassanoPLegerPCorvolPMenardJ. Systemic hypertension after cardiac transplantation: effect of cyclosporine on the renin-angiotensin-aldosterone system. Am J Cardiol. 1985;56(15):927–931.
20.
McKoyRUretskyBKormosRHardestyRGriffithBSalerniR. Left ventricular hypertrophy in cyclosporine induced systemic hypertension after cardiac transplantation. Am J Cardiol. 1988;62(16):1140–1142.
21.
GrimmMRinaldiMYonanN. Superior prevention of acute rejection by tacrolimus vs. cyclosporine in heart transplant recipients—a large European trial. Am J Transplant2006;6(6):1387–1397.
22.
Crespo-LeiroMGAlonso-PulpónLVázquez de PradaJA. Malignancy after heart transplantation: incidence, prognosis and risk factors. Am JTransplant. 2008;8(5):1031–1039.
23.
PennI. The effect of immunosuppression on pre-existing cancers. Transplantation. 1993;55(4):742–747.
24.
EdwardsBHuntSFowlerMValantineHStinsonESchroederJ. Cardiac transplantation in patients with preexisting neoplastic diseases. Am J Cardiol. 1990;65(7):501–504.
25.
PedottiPPoliFLonghiE. Epidemiologic study on the origin of cancer after kidney transplantation. Transplantation. 2004;77(3):426–428.
26.
AnyanwuATownsendEBannerNBurkeMKhaghaniAYacoubM. Primary lung carcinoma after heart or lung transplantation: management and outcome. J Thorac Cardiovasc Surg. 2002;124(6):1190–1197.
27.
SwerdlowAHigginsGHuntB. Risk of lymphoid neoplasia after cardiothoracic transplantation. a cohort study of the relation to Epstein-Barr virus. Transplantation. 2000;69(5):897–904.
OswaldHSchultz-WildelauCGardiwalA. Implantable defibrillator therapy for ventricular tachyarrhythmia in left ventricular assist device patients. Eur J Heart Fail. 2010;12(6):593–599.
31.
SimonMA. Assessment and treatment of right ventricular failure. Nat Rev Cardiol. 2013;10(4):204–218.
32.
RainaASeetha RammohanHRGertzZMRameJEWooYJKirkpatrickJN. Postoperative right ventricular failure after left ventricular assist device placement is predicted by preoperative echocardiographic structural, hemodynamic and functional parameters. J Card Fail. 2013;19(1):16–24.
33.
CarrelTEnglbergerLMartinelliMV. Continuous flow left ventricular assist devices: a valid option for heart failure patients. Swiss Med Wkly. 2012;142:w13701.
34.
RoseEAGelijnsACMoskowitzAJ. Randomized evaluation of mechanical assistance for the treatment of congestive heart failure (REMATCH) study group. long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med. 2001;345(20):1435–1443.
35.
HortonSCKhodaverdianRChatelainP. Left ventricular assist device malfunction: an approach to diagnosis by echocardiography. J Am Coll Cardiol. 2005;45(9):1435–1440.
36.
ManciniDMBeniaminovitzALevinH. Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure. Circulation. 1998;98 (22):2383–2389.
37.
Gómez BuenoMSegoviaJLuis Alonso PulpónJL. Asistencia mecánica circulatoria y trasplante cardiaco. Indicaciones y situación en España. Rev Esp Cardiol. 2006;6(suppl F):82–94.
38.
DandelMWengYSiniawskiHPotapovELehmkuhlHBHetzerR. Long-term results in patients with idiopathic dilated cardiomyopathy after weaning from left ventricular assist devices. Circulation. 2005;112(9 suppl):I37–I45.
39.
BirksEJTansleyPDHardyJGeorgeRSBowlesCTBurkeM. Left ventricular assist device and drug therapy for the reversal of heart failure. N Engl J Med2006;355(18):1873–1884.
40.
TerraccianoCMHardingSEAdamsonDKobanMTansleyPBirksEJ. Changes in sarcolemmal Ca entry and sarcoplasmic reticulum Ca content in ventricular myocytes from patients with end-stage heart failure following myocardial recovery after combined pharmacological and ventricular assist device therapy. Eur Heart J2003;24(14):1329–1339.
41.
TerraccianoCMHardyJBirksEJKhaghaniABannerNRYacoubMH. Clinical recovery from end-stage heart failure using left-ventricular assist device and pharmacological therapy correlates with increased sarcoplasmic reticulum calcium content but not with regression of cellular hypertrophy. Circulation2004;109(19):2263–2265.
42.
LongJWKfouryAGSlaughterMSSilverMMilanoCRogersJ. Long-term destination therapy with the HeartMate XVE left ventricular assist device: improved outcomes since the REMATCH study. Congest Heart Fail. 2005;11(3):133–138.
43.
SlaughterMSRogersJGMilanoCARussellSDConteJVFeldmanD (2009) Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med2009;361(23):2241–2251.
44.
KirklinJKNaftelDCKormosRL. Third INTERMACS Annual Report: the evolution of destination therapy in the United States. J Heart Lung Transplant. 2011;30(2):115–123.
45.
SlaughterMSPaganiFDRogersJG. Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. J Heart Lung Transplant2010;29(suppl 4):S1–S39.
46.
GeorgeRSYacoubMHBowlesCT. Quality of life after removal of left ventricular assist device for myocardial recovery. J Heart Lung Transplant. 2008;27 (2):165–172.
47.
ParissisH. Hemodynamics effects of the use of the intraaortic balloon pump. Hellenic J Cardiol. 2007;48(6):346–351.
48.
SjauwKDEngströmAEVisMM. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?Eur Heart J. 2009;30(4):459–468.
49.
UnverzagtSMachemerMTSolmsA. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shoc. Cochrane Database Syst Rev. 2011;(7):CD007398.
50.
ThieleHZeymerUNeumannFJ. IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367(14):1287–1296.
51.
de WahaSDeschSEitelI. What is the evidence for IABP in STEMI with and without cardiogenic shock?Ther Adv Cardiovasc Dis. 2012;6(3):123–132.
52.
ChengJMden UilCAHoeksSE. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30(17):2102–21108.
53.
KoitabashiNKassDA. Reverse remodelling in heart failure-mechanisms and therapeutic opportunities. Nat Rev Cardiol. 2011;9(3):147–157.
54.
NeytMVan den BruelASmitYDe JongeNErasmusMVan DijkDVlayenJ. Cost-effectiveness of continuous-flow left ventricular assist devices. Int J Technol Assess Health Care. 2013;29(3):254–260.
55.
HufnagelCHDiaz VilegasPNahasH. Experiences with new types of aortic valvular prosthesis. Ann Surg. 1958;147(5):636–644.
56.
WebbSPasupatiKHumphriesC. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007;116(7):755–763.
57.
RoseJCHufnagelCAFreisEDHarveyPPartenopeA. The hemodynamic alterations produced by a plastic valvular prosthesis for severe aortic insufficiency in man. J Clin Invest. 1954;33(6):891–890.
58.
MacleverJRossHJ. Quality of life en left ventricular assist device support. Circulation. 2012;126(7):866–875.
59.
NeytMVan der BruelASmitY. Cost-effectiveness of continuous-flow Leith ventricular assist devices. Int J Technol Assess Health Care. 2013;29(3):254–260.
60.
AtluriPGoldstoneABKobrinDM. Ventricular assist device implant in the elderly is associated with increased, but respectable risk: a multi-institutional study. Ann Thorac Surg. 2013;96(1):141–147.
