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Int J Mol Sci. 2019 Aug 5;20(15). pii: E3823. doi: 10.3390/ijms20153823.

Hurdles to Cardioprotection in the Critically Ill.

Author information

1
Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia. l.seehoe@uq.edu.au.
2
Faculty of Medicine, University of Queensland, Chermside 4032, Australia. l.seehoe@uq.edu.au.
3
Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia.
4
Science and Engineering Faculty, Queensland University of Technology, Chermside 4032, Australia.
5
School of Medical Science, Griffith University, Southport 4222, Australia.
6
Faculty of Medicine, University of Queensland, Chermside 4032, Australia.

Abstract

Cardiovascular disease is the largest contributor to worldwide mortality, and the deleterious impact of heart failure (HF) is projected to grow exponentially in the future. As heart transplantation (HTx) is the only effective treatment for end-stage HF, development of mechanical circulatory support (MCS) technology has unveiled additional therapeutic options for refractory cardiac disease. Unfortunately, despite both MCS and HTx being quintessential treatments for significant cardiac impairment, associated morbidity and mortality remain high. MCS technology continues to evolve, but is associated with numerous disturbances to cardiac function (e.g., oxidative damage, arrhythmias). Following MCS intervention, HTx is frequently the destination option for survival of critically ill cardiac patients. While effective, donor hearts are scarce, thus limiting HTx to few qualifying patients, and HTx remains correlated with substantial post-HTx complications. While MCS and HTx are vital to survival of critically ill cardiac patients, cardioprotective strategies to improve outcomes from these treatments are highly desirable. Accordingly, this review summarizes the current status of MCS and HTx in the clinic, and the associated cardiac complications inherent to these treatments. Furthermore, we detail current research being undertaken to improve cardiac outcomes following MCS/HTx, and important considerations for reducing the significant morbidity and mortality associated with these necessary treatment strategies.

KEYWORDS:

cardioprotection; heart failure; heart transplantation; mechanical circulatory support

PMID:
31387264
PMCID:
PMC6695809
DOI:
10.3390/ijms20153823
[Indexed for MEDLINE]
Free PMC Article

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