Evidence-based surgery for chronic heart failure

• Autores: Stephen Westaby
• Localización: Medicine, ISSN-e 1357-3039, Vol. 42, Nº. 10, 2014, págs. 574-578
• Idioma: inglés
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• Resumen

  • Heart failure is a common and progressive syndrome leading to death. Symptoms of breathlessness and fatigue are eventually intolerable. Conventional operations including valve repair, revascularization of hibernating myocardium and left ventricular remodelling interrupt the downward spiral providing symptomatic relief in suitable candidates. For a tiny minority of highly selected young patients who are already dependent on inotropes or mechanical circulatory support, cardiac transplantation is an invaluable solution. Survival is 84% at 1, 6% at 10, and 20% at 20 years. By 10 years 30% have developed malignancy. For those without access to a donor heart, small implantable rotary blood pumps have emerged as an effective off the shelf alternative. Developments in bioengineering, together with elective implantation before cardiogenic shock, have elevated survival rates to compete with transplantation. Thromboembolic bleeding and infection rates are falling with improved clinical management. The outstanding issue for the NHS is cost and the ethical dilemma of withholding life saving treatment on economic grounds.