Term Paper: Congestive Heart Failure CHF

Pages: 10 (3053 words)  ·  Bibliography Sources: 1+  ·  Level: College Senior  ·  Topic: Disease  ·  Buy This Paper

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[. . .] Those four surgical options are:

Traditional bypass surgery with or without combination surgical treatments

Implantation of ventricular assist devices

Ventricular Reduction Surgery of two main types

Heart Transplantation

Within these four surgical interventions as is known are many stipulations for action, care and means for recovery.

Traditional bypass surgery as discussed before is an option for many patients with extreme arterial degeneration and possibly valve damage. Yet, the traditional bypass reduces the load on the patients natural heart but does not always reduce the disease process or eliminate the need for further intervention, in the form of additional bypass surgeries or other means of intervention. Though still widely effective and widely practiced, the recovery and extreme nature of the surgical intervention can be deterrents to such an intervention.

The implantation of ventricular assist devices, though not terribly common is become more widely available across the country. As more and more patients undergo bridge to transplant treatment with these devices the research obtained has led to the acceptance of at least one of these devices for permanent implantation. The purpose and function of a ventricular assist device is to bypass the Left Ventricle of the patients natural heart to improve pulmonary cardiac output. The implanted portion of the device is a fist sized titanium pump lined internally with a material that allows the growth of scar tissue that both cushions blood cells and reduces risk of stroke. The contraindications for the implantation of such a device would be a non-functioning right heart and an inability to obtain enough social support to live with and care for a rather complicated device.

The implanted portion of the device is a fist sized titanium pump lined internally with a material that allows the growth of scar tissue that both cushions blood cells and reduces risk of stroke. The power supply of the device is external, the patient is either attached to a large, wall unit that powers the device or they are attached to a double set of lead batteries worn in a sling over the sides and both options are available to the patient at all times. There is also and emergency hand pump, (as well as an injectable emergency anticoagulant used if the power to the device has been removed for longer than two minutes or an unknown amount of time) in the case of complete power failure of both the wall unit and the battery packs. The permanent exit wounds require great care and constant monitoring. Special training is needed and care can seem complicated to both the patient and care providers but the system allows patients to strengthen cardiac output and potentially overall health through bypassing the sick parts of the heart.

The HeartMate VE Left Ventricular Assist Device, described above has recently been approved for non-transplant eligible implantation as well as bridge to transplant patients and other systems are such as the Thoratec LVAD/RVAD/BiVAD, and the Abiomed BVS 5000 LVAD/RVAD/BiVAD are all available in different regions, at different hospitals for bridge to transplant patients. (Strong Health and Vascular Center Web site: (http://www.stronghealth.com/services/surgical/Cardiothoracic/heartfailure.cfm) Most transplant care systems, and a few regional artificial heart teams have vast amounts of information associated with these implantable devices and as the body of research grows so does the technological advances of such devices.

Though traditionally the two greatest possible negative outcomes for patients are stroke, associated with the formation of blood clots inside the assist device, and the failure of an already compromised patient to have functional healing at the pneumatic and electrical exit site wound, a permanent part of the FDA approved HeartMate pneumatic LVAD. The trial studies are well advanced for devices with different working mechanisms and different power supply standards and will undoubtedly become available in the coming years.

Ventricular Mass Reduction Surgery, also known as a Partial Left

Ventriculectomy is a less widely used procedure that has only recently been approved by the FDA for treatment of CHF. The traditional type of Ventricular Mass Reduction Surgery known as the Batista method has a larger scope of surgical intervention than comparative Left Ventricular Aneurysmectomy, where only the dead or ischemic portion of the left ventricle is removed. In early clinical trials comparing the two methods did determine a slightly statistically higher death rate with the Ventricular Reduction Surgery but more work will undoubtedly be done in the future.

Left ventricular reduction surgery is associated with a higher in-hospital mortality than the well established procedure of left ventricular aneurysmectomy. This may be partially explained by a lower preoperative left ventricular ejection fraction of the pts from group I and II. NYHA functional class of surviving pts after partial left ventriculectomy improved although there was no significant postoperative increase in left ventricular ejection fraction. (Claus M, Beling M, Grohmann A, Konertz W, Baumann G. 2000)

Very recently a new method of Ventricular Mass Reduction Surgery, involving the implantation of has begun to be tested and used as a therapeutic option for certain CHF patients using the implantation of bovine cardiac tissue in addition to the surgical reduction and removal of ischemic and/or damaged left ventricular cardiac tissue.

October 30, 2003 - Cardiothoracic surgeons at Borgess Medical Center now perform a new procedure, called surgical ventricular restoration (SVR), using an implant made from bovine pericardium for patients who have certain types of severe congestive heart failure (CHF). The soft and flexible oval-shaped patch used to repair left ventricle damage is part of the CorRestore System made by Somanetics. Alphonse DeLucia, MD; Michael Khaghany, MD; and George Mack, DO, of CardioThoracic Surgery, P.C., in Kalamazoo... (PR Web News Release 2003)

According to physicians at Borgess Medical Center, the only place the surgery was done as of late 2003 their reasons for the trial of the surgery are thus:

Medication and cardiac-assist devices might alleviate symptoms of heart failure, but these treatments do not address the underlying cause of the disease, which is weakening and enlargement of the heart's main pumping chamber," said Dr. DeLucia. "These treatments are also riskier. SVR with the CorRestore System approaches CHF from the perspective of the illness itself, not only restoring the diseased heart, but, by extension, improving the performance of other organs and the patient's quality of life." (PR Web News Release 2003)

All of the above surgical procedures are needed alternatives or bridges to a natural heart transplant. Though a heart transplant may be the best option in many cases the availability of donor organs is very limited and in acute CHF (especially post MI) the wait time for a natural heart donation can be fatal for the patient. Many of the procedures are thought of as potential replacement for the need for natural heart transplantation, with its well detailed drawbacks, such as rejection, continued immune suppression, infection and simply a wait that outlast the living patient.

A for many patients with very advanced heart failure, this operation is lifesaving and restores them to health for quite some time. But I would be lying to readers if I were to say that transplantation is a "cure" for heart failure. I believe the more balanced view is to say that it is a compromise, exchanging one set of problems (those of heart failure) with another set of problems (those of heart transplantation). (Silver, Stevenson & Silver 2000)

The research and development associated with CHF will continue exponentially as the disease and the elderly population grows. Options are increasing and patients who meet the criteria for these options are becoming more and more aware of them, as are the physicians who are banded together in the cardiac health specialty to meet their needs.

Works Cited

Adult Health Advisor 2002, "Congestive Heart Failure" Clinical Reference Systems

Annual 2002: 792.

CDC MMWR Weekly "Mortality from Congestive Heart Failure -- United States, 1980-

1990" February 11, 1994 / 43(05);77-81. Retrieved July, 7 2004 at http://www.cdc.gov/mmwr/preview/mmwrhtml/00024847.htm.

Claus M, Beling M, Grohmann A, Konertz W, Baumann G. "Left Ventricular

Reduction Surgery Compared with Left Ventricular Aneurysmectomy,"

Cardiovascular Surgery June 2000, 16-17.

Hajjar RJ, MacRae CA. Adrenergic-receptor polymorphisms and heart failure. New England Journal of Medicine 2002;347:1196-9.

Little, Julian "Congestive heart failure and adrenergic receptor polymorphisms"

Office of Genomics and Disease Prevention, CDC Epidemiology Group,

Department of Medicine & Therapeutics, Aberdeen University, Aberdeen, UK

November 27, 2002. Retrieved July 7, 2004 at http://www.cdc.gov/genomics/hugenet/ejournal/heartfailure.htm#one.

National Heart, Lung, and Blood Institute. Morbidity & mortality: 2002 chart book on cardiovascular, lung, and blood diseases. 2002. Bethesda, MD: U.S. Department of Health and Human Services.

A www.questia.com/PM.qst?a=o&d=5001696867

Phelps, Jerry. "Genetic Susceptibility: A Higher Risk of Congestive Heart Failure in Blacks Genetics May Be Responsible." Environmental Health Perspectives 111.2 (2003): 91. Questia. 9 July 2004 http://www.questia.com/.

PR Web Press Release November 1, 2003 "Breakthrough Surgical Treatment for Congestive Heart Failure to be Webcast LIVE from Borgess… [END OF PREVIEW]

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