End-stage heart failure: which options?

Abstract

Randomized clinical trials have established the roles of angiotensin-converting enzyme inhibitors, beta-blockers, spironolactone, mechanical circulatory support devices and defibrillators in advanced heart failure. Observational data support the use of cardiac surgical interventions, including revascularization, mitral valve repair, left ventricular geometry restoration, re synchronization therapy and cardiac transplantation. The potential of gene therapy, cell transplantation and xenotransplantation is actively being explored. Comprehensive heart failure centres with expertise in all aspects of medical and surgical advanced heart failure care are evolving, and aim to translate evidence-based management protocols into effective clinical practice.