Document Detail

Managing drugs and devices in patients with permanent ventricular assist devices.
MedLine Citation:
PMID:  17761117     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Patients will be considered for destination mechanical circulatory support device (MCSD) implantation when all other organ-saving treatment options have failed and they are not eligible for heart transplantation. Current medical evidence suggests that only for those patients who are inotrope-dependent and therefore likely have a 1-year survival probability without MCSD implantation of less than 50%, MCSD intervention will add to survival and quality-of-life benefit. Suitable candidates for MCSD are those patients who have a high risk of dying from heart failure but acceptable noncardiac risk. Evaluation of patients for MCSD requires a systematic and critical review of all organ systems and of the psychosocial situation. Specifically, right ventricular function and risk of right ventricular failure should be evaluated before planning destination MCSD implantation. Treatment will focus on prompt recovery from MCSD implantation, maintaining optimal treatment for heart failure, and preventing/treating MCSD complications, including infection, bleeding, coagulopathy, right heart failure, and device dysfunction. MCSD programs should be organized as an advanced heart failure center directed by specialized heart failure cardiologists, surgeons expert at implant and management of MCSD, specialized nurses, social workers, psychologists, financial experts, and physical therapists. MCSD practice is based on a patient-centered theory, with an appropriate understanding of the respective roles of the physician and the patient during their iterative encounters in which the patient is an autonomous person making responsible personal health decisions while the health care team is providing continued expert and empathic counseling about various options, based on systematic outcomes research (eg, by participation in the Interagency Registry for Mechanically Assisted Circulatory Support - MCSD database ).
Martin Cadeiras; Manuel von Bayern; Mario C Deng
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in cardiovascular medicine     Volume:  9     ISSN:  1092-8464     ISO Abbreviation:  Curr Treat Options Cardiovasc Med     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-31     Completed Date:  2010-06-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815942     Medline TA:  Curr Treat Options Cardiovasc Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  318-31     Citation Subset:  -    
Cardiac Transplantation Research, Division of Cardiology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York Presbyterian Hospital, PH Room 1291, 622 W. 168th Street, New York, NY 10032, USA.
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