Related Experiment Video
Updated: Jul 16, 2026
Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
End-stage chronic heart failure
G Leibundgut1, Hans Peter Brunner-La Rocca
1Cardiology, University Hospital Basel, Basel, Switzerland.
Insights
Optimizing medical therapy for congestive heart failure (CHF) involves careful titration, accepting certain side effects. Advanced treatments like cardiac resynchronization therapy (CRT) and heart transplantation offer options for persistent symptoms.
Area of Science:
- Cardiology
- Heart Failure Management
Background:
- Congestive heart failure (CHF) remains progressive despite therapeutic advancements.
- Many patients experience persistent symptoms even with broadened medical therapy.
- Therapeutic escalation is often limited by perceived, rather than actual, intolerability of side effects.
Purpose of the Study:
- To review current therapeutic strategies for managing advanced congestive heart failure.
- To emphasize the importance of adequate medical therapy optimization before considering advanced interventions.
- To discuss the role of cardiac resynchronization therapy (CRT), implantable defibrillators (ICD), heart transplantation, and assist devices.
Main Methods:
- Review of existing literature on end-stage congestive heart failure management.
- Analysis of acceptable side effect parameters for medical therapy titration (e.g., creatinine increase, hyperkalemia).
- Evaluation of indications and outcomes for advanced therapies including CRT, ICD, and heart transplantation.
Main Results:
- Acceptable side effects for medical therapy include serum creatinine increase (30-50%) and hyperkalemia (up to 5.5 mmol/l).
- Cautious and slow uptitration of medical therapy is crucial, especially in severe CHF.
- Cardiac resynchronization therapy (CRT) significantly improves symptoms and prognosis in selected patients.
- Combined CRT and ICD therapy may benefit patients by improving functional status.
- Heart transplantation and assist devices remain options for end-stage CHF, with evolving roles.
Conclusions:
- Optimizing medical therapy, including careful titration and acceptance of manageable side effects, is paramount in congestive heart failure (CHF).
- Advanced therapies such as cardiac resynchronization therapy (CRT), implantable defibrillators (ICD), and heart transplantation offer significant benefits for patients with refractory symptoms.
- Future therapeutic options for end-stage CHF are expected to expand with ongoing research and device development.
Abstract:
Congestive heart failure (CHF) has kept its progressive nature despite significant advances in therapy. With more advanced disease, medical therapy is broadened. Even so, some patients remain severely symptomatic. However, before additional action is taken, it should be regarded if therapy really fails. Often, therapy is not increased sufficiently because of assumed rather than actual intolerability. Thus, increase in serum creatinine up to 30-50%, hyperkaliemia up to 5.5 mmol/l, and asymptomatic hypotension and bradycardia are usually acceptable. Cautious and slow start and uptitration are the more important the more severe heart failure is, but these patients also profit most from this therapy. If patients remain severely symptomatic despite adequate medical therapy, cardiac resynchronisation therapy (CRT) should be considered. It significantly improves both symptoms and prognosis. Although implantable defibrillators (ICD) are less effective in end-stage CHF, CRT and ICD may be combined as CRT may improve function status, making patients eligible also for ICD therapy. In selected patients, heart transplantation is still an option if no other therapeutic options are effective and there are no contraindications. In these patients, prognostic assessment of CHF is particularly important. Assist devices are used as bridge to transplant or more seldom to recovery only in many countries, but destination therapy may become more important in future therapy with improved devices. Many other therapies are under investigation at present. Thus, therapeutic options for end-stage CHF may further broaden in the near future.
Related Concept Videos
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:17Pathophysiology of Heart Failure
01:26Heart Failure III: Clinical Manifestations
01:29Heart Failure II: Pathophysiology
01:22Heart Failure VI: Adjunct Therapies
01:30Heart Failure V: Medical Management