Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Terminal heart failure treatment strategies

Authors: A.N. Makhmudova

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation Aziza N. Makhmudova, Cardiologist; orcid.org/0000-0002-0668-0559

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2020-17-1-13-23

UDC: 616.12-008.46

Link: Clinical Physiology of Blood Circulaiton. 2020; 17 (1): 13-23

Quote as: Makhmudova A.N. Terminal heart failure treatment strategies. Clinical Physiology of Circulation. 2020; 17 (1): 13–23 (in Russ.). DOI: 10.24022/1814-6910-2020-17-1-13-23

Received / Accepted:  19.11.2019/29.11.2019

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Abstract

The problem of treatment of heart failure is one of the most discussed. Drug therapy is at a high level due to modern ideas about the pathogenesis and pathomorphology of the disease, and the presence of pharmacological and other methods of their correction. However, sometimes the possibilities of drug therapy are limited, and this has served as an incentive to search for non-pharmacological methods of treating heart failure. Remote monitoring of outpatients with heart failure, has demonstrated, in some cases, the need to use invasive methods of treatment in order to save the patient's life.

The clinical effectiveness and safety of resynchronization therapy in the treatment of drug-resistant heart failure is beyond doubt, and is confirmed by large studies. The use of artificial mechanical circulatory support systems has also been included in the treatment protocol for patients with heart failure. Over the past decade, the use of mechanical circulatory support systems in clinical practice has increased significantly, and strategies for using the method have been improved. The accumulated experience in twostage heart transplantation, using implantable artificial heart ventricular systems capable of providing mechanical support for 200–500 days, with complete restoration of the pumping function of the heart, raised the question of the possibility of using mechanical circulatory support systems as a "bridge" for restoration heart muscle.

Heart transplantation has firmly taken its place in the arsenal of treatment methods for patients with irreversible myocardial diseases. For most patients in the terminal stage of heart failure, it is the only cure. Currently, more than 3,000 such operations are performed annually in the world.

Тhe variety of approaches and methods used in the treatment of this difficult contingent of patients indicates an inexhaustible interest in the issue. The problem of finding the optimal drug algorithm and methods for surgical treatment of terminal heart failure remains one of the burning problems in modern cardiology and cardiac surgery.

About Authors

Aziza N. Makhmudova, Cardiologist; orcid.org/0000-0002-0668-0559

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