New surgical methods of treating advanced heart failure

For many decades, heart transplantation has been the “gold standard” for terminal chronic heart failure resistant to medical therapy treatment. However, there is a significant number of patients with contraindications to orthotopic heart transplantation. The only effective treatment method for these patients may be the implantation of long-term mechanical circulatory support systems. This article provides information for practicing physicians on the evolution of long-term mechanical circulatory support systems, the main criteria for selecting patients for implantation, and the specifics of their subsequent outpatient monitoring.

1. Heart failure. National recommendations of the OSS, RKO and RNMOT. 2022. (In Russian)].

2. Polyakov D.S., Fomin I.V., Belenkov Yu.N., Mareev V.Yu., Ageev F.T., Artemyeva E.G. et al. Chronic heart failure in the Russian Federation: what has changed in 20 years of observation? The results of the EHPOKHA–KHSN study. ISSN 0022-9040. Cardiology. 2021;61(4). (In Russian)]. DOI: 10.18087/cardio.2021.4.n1628

3. Tereshchenko S.N., Galyavich A.S., Uskach T.M., Ageev F.T., Arutyunov G.P., Begrambekova Yu.L. et al. Chronic heart failure. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(11):311–374. (In Russian)].

4. Heart transplantation, the presence of a transplanted heart, death and rejection of a heart transplant. Clinical recommendations. 2023– 2024–2025 (16.03.2023). (In Russian)]. [Electronic resource]. URL: https://cr.minzdrav.gov.ru/recomend/762_1.

5. Kilic A., Conte J.V., Shah A.S., Yuh D.D. Orthotopic heart transplantation in patients with metabolic risk factors. Ann. Thorac. Surg. 2012;93(3):718–724.

6. Gautier S.V., Shevchenko A.O., Itkin G.P., Zakharevich V.M., Poptsov V.N., Drobyshev A.A., Telyshev D.V. Artifi cial Heart in Russia: past, present, and future Artifi cial Organs. 2020.

7. Liotta D., Hall C.W., Henly W.S. Prolonged assisted circulation during and after cardiac or aortic surgery. prolonged partial left ventricular bypass by means of intracorporeal circulation. Am. J. Cardiol. 1963. № 12 P. 399–405.

8. Cooley D.A., Liotta D., Hallman G.L. Orthotopic cardiac prosthesis for two-staged cardiac replacement. Am. J. Cardiol. 1969;24:723–30.

9. DeVries W.C., Anderson J.L., Joyce L.D. Clinical use of the total artifi cial heart. N. Engl. J. Med. 1984;310(5):273–78.

10. Kilic A., Weiss E.S., George T.J., Arnaoutakis G.J., Yuh D.D. What predicts long-term survival after heart transplantation? An analysis of 9,400 ten-year survivors. Ann. Thorac. Surg. 2012;93(3):699–704.

11. Portner P.M., Oyer P.E., Pennington D.G. Implantable electrical left ventricular assist system — bridge to transplantation and the future. Ann. Thorac. Surg. 1989;47(1):142–150.

12. Pagani F.D., Miller L.W., Russell S.D., Aaronson K.D. Extended mechanical circulatory support with a continuous-fl ow rotary left ventricular assist device. J. Am. Coll. Cardiol. 2009;54(4):312–321.

13. Rogers J.G., Aaronson K.D., Boyle A.J., Russell S.D. Continuous fl ow left ventricular assist device improves functional capacity and quality of life of advanced heart failure patients. J. Am. Coll. Cardiol. 2010;55(17):1826–1834.

14. Itkin G.P. Mechanical support of blood circulation: problems, solutions and new technologies. Bulletin of Transplantology and artifi cial organs. 2014;16(3):76–84. (In Russian)]. DOI: 10.15825/1995-1191-2014-3-76-84

15. Gauthier S.V., Itkin G.P., Shemakin S.Yu., Saitgareev R.Sh., Poptsov V.N., Za kharevich V.M.et al. The fi rst experience of clinical application of a domestic device auxiliary blood circulation based on an implantable axial pump for two-stage heart transplantation. Bulletin of Transplantology and artifi cial organs. 2013;15(3):92–101. (In Russian)].

16. Long J.W., Kfoury A.G., Slaughter M.S., Sliver M., Milano C., Rogers J. Long-term destination therapy with the HeartMate XVE left ventricular assist device — improved outcomes since the REMATCH Study Congest. Heart Fail. 2005;11(3):133–138.

17. James K. Kirklin, MD The 2023 ISHLT guidelines for durable mechanical circulatory support: A must read for all advanced heart failure practitioners . J. Heart Lung Transplant.

18. Stevenson L.W., Pagani F.D. INTERMACS profi les of advanced heart failure — the current picture. J. Heart Lung Transplant. 2009;28(6):535–41.

19. Khalilulin T.A., Zakharevich V.M., Poptsov V.N., Itkin G.P., Shevchenko A.O., Saitgareev R.S.et al. Features of implantation of the AVK-N pumping function support system as a “bridge” to heart transplantation. Bulletin of Transplantology and artifi cial organs. 2018:20(1):13–22. (In Russian)].

20. Stevenson L.W. Clinical use of inotropic therapy for heart failure. Looking backward or forward? Part II. Chronic inotropic therapy. Circulation. 2003;108(4):492–497.

21. Najjar S.S., Slaughter M.S., Pagani F.D., Starling R.C. An analysis of pump thrombus events in patients in the HeartWare ADVANCE bridge to transplant and continued access protocol trial. J. Heart Lung Transplant. 2014;33(1):23–24.

22. Jennings D.L., Jacob M., Chopra A., Nemerovski C.W. Safety of anticoagulation reversal in patients supported with continuous-fl ow left ventricular assist devices. ASAIO J. 2014;60(4):381–384.

23. Saeed et al. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10-Year Update. J. Heart Lung Transplant. 2023;42(7).