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Despite the significant decline in heart disease mortaht>' rates over the last 25 years, heart failure has remained a significant problem. We are now confronted with large numbers of terminally ill patients for whom conventional therapies for heart failure have been exhausted and for whom repeated hospital visits are necessary. There now is a major thrust towards a management strategy which embraces a comprehensive approach including vigorous preventive measures and earlier surgical interventions. This book outlines the major surgical options for the treatment of heart failure and brings together a very broad base of opinions with contributions from several outstanding individuals. With the improved knowledge and techniques to control rejection, transplantation has become the central pillar in the surgical management of this group of patients. Unfortunately, because of limited donor supply the teclmique cannot be applied to large numbers of patients. A great deal of excitement, however, exists in the potential for xenotransplantation as a supplement to homotransplantation. The use of cardiac assist devices has become a reality with several hundred LVADS and BiVADS implanted throughout the world and cardiac replacement with total artificial hearts continues to be used successfully as a bridge to transplantation. We are on the thieshold of the broad application of assist devices to provide prolonged relief of heart failure and restore patients to an ambulatoiy home environment and hopefully return to the work force in significant numbers.
James C. Fang, MD, and Gregory S. Couper, MD, have assembled a panel of prominent surgeons and cardiologists to review the latest clinical, scientific, and investigational surgical and mechanical approaches to heart failure in hopes of improving the lives of this challenging group of patients. Topics range from such traditional strategies as high-risk surgical revascularization in advanced coronary artery disease, to more novel approaches such as ventricular reconstruction and mechanical assist devices. Many chapters are contributed by the original pioneers of specific surgical techniques, which provide s invaluable perspective from personal experience.
For many years, there has been a great deal of work done on chronic congestive heart failure while acute heart failure has been considered a difficult to handle and hopeless syndrome. However, in recent years acute heart failure has become a growing area of study and this is the first book to cover extensively the diagnosis and management of this complex condition. The book reflects the considerable amounts of new data reported and many new concepts which have been proposed in the last 3-4 years looking at the epidemiology, diagnostic and treatment of acute heart failure.
Surgical Management of Heart Failure brings together the current knowledge on the surgical management of heart failure into one volume. It is designed to have copious illustrations and photographic material that will explain the techniques and surgical management of patients with heart failure in an effective modern format.
Congestive heart failure (CHF) is one of the most common killers worldwide and is becoming more prevalent as the population continues to age. Despite great advances in medical drug treatment and the liberal use of pacemakers and internal defibrillators, the outcome of CHF remains poor, which has prompted investigators to consider new surgical options for its management. This special issue compiles contributions from a select group of investigators and experts from premier medical centers. It covers many important topics, including aortic valve replacement for valvular cardiomyopathy, mitral valve repair, myocardial revascularization in patients with ventricular dysfunction, the pros and cons of beating heart versus on-pump coronary artery bypass surgery (CABG), and clinical trials comparing CABG to percutaneous coronary interventions. The ongoing clinical trials in the surgical management of CHF, the experience with ventricular reduction and remodeling surgery as well as the current status of heart transplantation are reviewed. Consideration is also given to resynchronization therapy and biventricular pacing for CHF, and the use of ventricular assist devices as destination therapy and as a bridge to transplantation or recovery. The reader is updated on the clinical experience with the Jarvik 2000 ventricular assist device and the AbioCor total artificial heart. Further novel approaches discussed are gene therapy for premature coronary artery disease, therapeutic angiogenesis, transmyocardial laser revascularization and cardiac xenotransplantation. This publication will be of special interest to clinicians and investigators in cardiology and cardiac surgery, medical and surgical residents and fellows in training, and general practitioners.
The treatment of end-stage heart failure with advanced surgical therapies has evolved significantly over the last several years and is a dynamic subspecialty within cardiac surgery. Surgical Treatment for Advanced Heart Failure describes the surgical management of advanced heart failure, including coronary artery revascularization, mitral valve repair, aortic valve replacement, ventricular remodeling, cardiac resynchronization, mechanical circulatory support with short-term devices for acute stabilization, long-term mechanical support as a bridge to transplant and for destination therapy, left ventricular assist devices, complete cardiac replacement with the total artificial heart, and cardiac transplantation. With contributions from a distinguished group of heart failure cardiologists and transplant surgeons, it is an authoritative resource for cardiac surgeons, cardiologists, and surgeons.
Despite all efforts and success in medical treatment, the incidence of (end-stage) chronic heart failure is increasing. Cardiac transplantation remains the only definite option; however, due to the shortage of donor organs, very few people benefit. Therefore, surgery of end-stage heart failure using conventional techniques has gained new interest after the introduction of the Batista operation. However, a clear surgical identification of the patients to be included in this group is lacking. Left ventricular reduction surgery as well as reduction of the base of the heart using mitral annuloplasty or mitral valve replacement, sparing both papillary muscles, is used in selected patients with satisfying results and good survival. Long-term mechanical support with subsequent surgical remodeling or supporting myoplasty may result in a beneficial alternative to heart transplantation.
This book has been conceived as a rapid but comprehensive review for practitioners of all persuasions involved in the management of patients with heart failure. Heart failure is a problem of epidemic proportions in all parts of the world. State of the art treatment may not be accessible to all, but simply creating an awareness of simple methods of diagnosis and treatment would assist in promoting a better global response to this epidemic. This updated second edition, written by a panel of world-renown cardiology experts, focuses on the surgical management of heart failure. Surgery for heart failure is an evolving and new area in cardiac surgery with many exciting developments. Management of Heart Failure, Volume 2: Surgical will be essential reading for all specialists dealing with patients with or who are at risk of heart failure, including but not limited to cardiologists, emergency medicine physicians, critical care physicians, anesthesiologists, interventionalists and cardiothoracic surgeons.
This book systematically focuses on central sleep apneas, analyzing their relationship especially with heart failure and discussing recent research results and emerging treatment strategies based on feedback modulation. The opening chapters present historical background information on Cheyne-Stokes respiration (CSR), clarify terminology, and explain the mechanics and chemistry of respiration. Following a description of the physiology of respiration, the pathophysiology underlying central apneas in different disorders and particularly in heart failure is discussed. The similarities and differences of obstructive and central apneas are then considered. The book looks beyond the concept of sleep apnea to daytime CSR and periodic breathing during effort and contrasts the opposing views of CSR as a compensatory phenomenon or as detrimental to the failing heart. The diagnostic tools currently in use for the detection of CSR are thoroughly reviewed, with guidance on interpretation of findings. The book concludes by describing the various forms of treatment that are available for CSR and by explaining how to select patients for treatment.