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Implantation of Total Artificial Heart in Congenital Heart Disease

Implantation of Total Artificial Heart in Congenital Heart Disease

Published on: July 18, 2014

Heart failure in adult congenital heart disease

Ada Stefanescu¹, Doreen DeFaria Yeh, David M Dudzinski

¹Division of Cardiology, Institute for Heart, Vascular and Stroke Care, Yawkey 5B, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA, ddefariayeh@mgh.harvard.edu.

Current Treatment Options in Cardiovascular Medicine

|August 19, 2014

Insights

Adult congenital heart disease (ACHD) management adapts standard therapies, lacking robust trials. Emerging evidence supports specific medical treatments, risk factor control, and novel prognostic tools for this growing patient population.

Area of Science:

Cardiology
Adult Congenital Heart Disease

Background:

Adult congenital heart disease (ACHD) patients are a growing, high-resource subgroup in cardiology.
A significant gap exists in randomized trial evidence for ACHD management.
Current therapies are often adapted from adult left ventricle systolic failure treatments.

Purpose of the Study:

To review current medical therapy approaches for adult congenital heart disease.
To highlight emerging evidence and novel prognostic tools in ACHD care.
To emphasize the need for tailored management strategies in ACHD.

Main Methods:

Review of existing literature and clinical practices in ACHD.
Discussion of adapted therapies from other cardiac conditions.
Exploration of emerging treatments and prognostic indicators.

Main Results:

Angiotensin antagonists show promise in preventing remodeling in systemic right ventricle patients.
Pulmonary vasodilators demonstrate potential benefits in ACHD.
Coronary risk factor control and aerobic exercise are recommended for all ACHD patients.
Multi-site pacing is an emerging therapy for arrhythmia prevention.
Natriuretic peptides and CPET are increasingly used for prognostic assessment.

Conclusions:

ACHD management requires specialized approaches due to a lack of robust trial data.
Evidence is growing for specific medical therapies, risk factor modification, and advanced prognostic tools.
Tailored therapeutic strategies are essential for optimizing outcomes in ACHD.

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Abstract

Opinion Statement:

Adult congenital heart disease (ACHD) patients represent a special population in modern cardiology: though their numbers are growing, and they represent a high-resource utilization subgroup, a robust evidence-base of randomized trials is lacking. Much of the standard therapy is adapted from the treatment of ischemic and idiopathic left ventricle systolic failure, with a small, but growing body of evidence on medical therapy in select ACHD diagnoses. At our institution, for instance, there is a long tradition of using angiotensin antagonists in patients with a systemic right ventricle to prevent deleterious remodeling. The effects of beta-blockers on functional class in ACHD are yet unproven, but there is promising data on pulmonary vasodilators. Control of coronary risk factors and aerobic exercise should be considered for all. Prevention of arrhythmias is important, and multi-site pacing is an emerging therapy. New prognostic tools including natriuretic peptides and CPET are increasingly used to guide earlier initiation of these therapies.

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