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KMID : 0614720080510040306
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Journal of Korean Medical Association
2008 Volume.51 No. 4 p.306 ~ p.316
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Treatment of Medically Intractable End-Stage Heart Failure
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Choi Jin-Ho
Jeon Eun-Seok
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Abstract
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Heart failure is the final pathway for myriad diseases that affect the heart. Patients with refractory symptoms of heart failure despite ultimate medical therapy have very poor prognosis. In these patients, replacement of failing heart with permanent organ transplantation or ventricular assist device, which is temporarily or permanently implanted, is often life-saving and can improve long term prognosis. Cardiac transplantation is the established standard for the treatment of end-stage cardiac disease refractory to medical therapy. The clinical success of transplantation has been streadily improving with the refinement of recipient selection, better donor management, and better immunosuppressive agents. Recent substantial evolution of mechanical circulatory assist devices improved dramatically the outcome of not only patients in decompensated heart failure but also a large proportion of acute heart failure patients in cardiogenic shock. With this evolution, implantable sophisticated devices are being used as destination therapy as a substitute for transplantation and are expected to diminish the intrinsic shortage of donor compared to the epidemic of heart failure.
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KEYWORD
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End-stage heart failure, Heart transplantation, Mechanical assist device
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