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Machines versus medication for biventricular heart failure: focus on the total artificial heart Francisco A Arabia*,1 & Jaime D Moriguchi1
ABSTRACT The medical/surgical management of advanced heart failure has evolved rapidly over the last few decades. With better understanding of heart failure pathophysiology, new pharmacological agents have been introduced that have resulted in improvements in survival. For those patients that fail to improve, mechanical circulatory support with left ventricular assist devices and total artificial hearts (TAHs) have served as a beneficial bridge to transplantation. The TAH has continued to play a significant role as a bridge to transplantation in patients with biventricular failure and more selected indications that could not be completely helped with left ventricular assist devices. Improved survival with the TAH has resulted in more patients benefiting from this technology. Improvements will eventually lead to a totally implantable device that will permanently replace the failing human heart. Congestive heart failure (CHF) represents a major burden to society both in the USA and around the world. Over 5.1 million individuals in the US alone carry this diagnosis, with nearly 550,000 new cases diagnosed each year [1] . Over US$32 billion dollars are spent for heart failure (HF)-related expenditures annually and represents the number one diagnosis-related grouping for hospital admissions. Despite continued advances in medical therapy and the widespread use of automatic cardioverter defibrillators (AICDs), only 50% of patients are alive at 5 years from the time of diagnosis, and for those with New York Heart Association (NYHA) functional class (FC) IV limitations, the 1-year mortality rate approaches 50% [2] . For the majority of patients with mild-to-moderate HF (NYHA FC I–III), lifestyle and dietary modifications in conjunction with the use of traditional HF medications are often successful in alleviating symptoms and maintaining reasonable survival. Angiotensin-converting enzyme (ACE) inhibitors, β-blockers and aldosterone antagonists titrated to effective doses have proven value in this group of individuals. Judicious use of diuretics in order to maintain euvolemic status and the implantation of an AICD with or without cardiac resynchronization therapy (CRT) represent the standard therapies for patients with low left ventricular (LV) ejection fractions (LVEF;
Machines versus medication for biventricular heart failure: focus on the total artificial heart Francisco A Arabia*,1 & Jaime D Moriguchi1
ABSTRACT The medical/surgical management of advanced heart failure has evolved rapidly over the last few decades. With better understanding of heart failure pathophysiology, new pharmacological agents have been introduced that have resulted in improvements in survival. For those patients that fail to improve, mechanical circulatory support with left ventricular assist devices and total artificial hearts (TAHs) have served as a beneficial bridge to transplantation. The TAH has continued to play a significant role as a bridge to transplantation in patients with biventricular failure and more selected indications that could not be completely helped with left ventricular assist devices. Improved survival with the TAH has resulted in more patients benefiting from this technology. Improvements will eventually lead to a totally implantable device that will permanently replace the failing human heart. Congestive heart failure (CHF) represents a major burden to society both in the USA and around the world. Over 5.1 million individuals in the US alone carry this diagnosis, with nearly 550,000 new cases diagnosed each year [1] . Over US$32 billion dollars are spent for heart failure (HF)-related expenditures annually and represents the number one diagnosis-related grouping for hospital admissions. Despite continued advances in medical therapy and the widespread use of automatic cardioverter defibrillators (AICDs), only 50% of patients are alive at 5 years from the time of diagnosis, and for those with New York Heart Association (NYHA) functional class (FC) IV limitations, the 1-year mortality rate approaches 50% [2] . For the majority of patients with mild-to-moderate HF (NYHA FC I–III), lifestyle and dietary modifications in conjunction with the use of traditional HF medications are often successful in alleviating symptoms and maintaining reasonable survival. Angiotensin-converting enzyme (ACE) inhibitors, β-blockers and aldosterone antagonists titrated to effective doses have proven value in this group of individuals. Judicious use of diuretics in order to maintain euvolemic status and the implantation of an AICD with or without cardiac resynchronization therapy (CRT) represent the standard therapies for patients with low left ventricular (LV) ejection fractions (LVEF;
