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Radical alternatives to transplantation
1Cleveland Clinic Foundation, Section of Heart Failure and Cardiac Transplant Medicine, OH 44195, USA.
Current Opinion in Cardiology
|March 1, 1997
Summary
Surgical options like partial left ventricular resection, dynamic cardiomyoplasty, and left ventricular assist devices offer alternatives for end-stage heart failure patients awaiting transplants. Ongoing trials assess their long-term efficacy and survival benefits compared to medical therapy.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Thousands of patients with end-stage heart failure die annually due to a shortage of donor hearts.
- Surgical interventions are explored as alternatives to heart transplantation.
Purpose of the Study:
- To review current surgical alternatives for end-stage heart failure.
- To discuss the status and ongoing research for partial left ventricular resection, dynamic cardiomyoplasty, and left ventricular assist devices.
Main Methods:
- Review of existing literature and ongoing clinical trials.
- Evaluation of partial left ventricular resection, dynamic cardiomyoplasty, and left ventricular assist devices (LVADs).
Main Results:
- Partial left ventricular resection shows immediate cardiac function improvement, with long-term success pending further follow-up.
- Dynamic cardiomyoplasty improves quality of life and symptoms in selected patients, but survival benefits are under investigation.
- Left ventricular assist devices are effective bridges to transplantation, with trials comparing their efficacy against medical therapy in advanced heart failure.
Conclusions:
- Partial left ventricular resection is an innovative procedure requiring long-term evaluation.
- Dynamic cardiomyoplasty offers symptomatic relief and improved quality of life, with survival benefit yet to be proven.
- Left ventricular assist devices show promise as a bridge to transplant and are being evaluated as a long-term alternative therapy.