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End-stage heart failure: which options?

M.C Deng*,1, D.D Ascheim1, N.M Edwards2 and Y Naka2

a Division of Circulatory Physiology, Department of Medicine, New York, New York, U.S.A.
b Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University College of Physicians & Surgeons, New York, New York, U.S.A.

* Correspondence: Mario C. Deng, MD, FESC, FACC, Director of Cardiac Transplantation Research, The Heart Failure Center & Division of Circulatory Physiology, Columbia University College of Physicians & Surgeons, New York Presbyterian Hospital, Milstein Hospital Building Room 5-407, 177 Fort Washington Avenue, New York, NY 10032, U.S.A.

Abstract

Randomized clinical trials have established the roles of angiotensin-converting enzyme inhibitors, beta-blockers, spironolactone, mechanical circulatory support devices and defibrillators in advanced heart failure. Observational data support the use of cardiac surgical interventions, including revascularization, mitral valve repair, left ventricular geometry restoration, re synchronization therapy and cardiac transplantation. The potential of gene therapy, cell transplantation and xenotransplantation is actively being explored. Comprehensive heart failure centres with expertise in all aspects of medical and surgical advanced heart failure care are evolving, and aim to translate evidence-based management protocols into effective clinical practice.

Key Words: Advanced heart failure • assist device • heart transplantation • neurohormonal blockade

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