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Harrison's Principles of Internal Medicine, 18e
| Part 10. Disorders of the Cardiovascular System > Section 4. Disorders of the Heart > |
Chapter 235. Cardiac Transplantation and Prolonged Assisted Circulation
Sections: Cardiac Transplantation and Prolonged Assisted Circulation: Introduction, Cardiac Transplantation, Prolonged Assisted Circulation, Further Readings.
Topics Discussed: assisted circulation; heart transplantation.
Excerpt:"Advanced or end-stage heart failure is an increasingly frequent sequela, as progressively more effective palliation for the earlier stages of heart disease and prevention of sudden death associated with heart disease become more widely recognized and employed (Chap. 234). When patients with end-stage or refractory heart failure are identified, the physician is faced with the decision of advising compassionate end-of-life care or choosing to recommend extraordinary life-extending measures. For the occasional patient who is relatively young and without serious comorbidities, the latter may represent a reasonable option. Current therapeutic options are limited to cardiac transplantation (with the option of mechanical cardiac assistance as a "bridge" to transplantation) or (at least in theory) the option of permanent mechanical assistance of the circulation. In the future, it is possible that genetic modulation of ventricular function or cell-based cardiac repair will be options for such patients. Currently, both approaches are considered to be experimental...."
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