Chapter 9

Interventional Therapy and Device Therapy

Polychronis Antonitsis, Chrysovalantou Nikolaidou and Antonios Ziakas


Despite therapeutic advances in the medical treatment of HF patients, the prognosis remains poor. Coronary revascularization in patients with ischaemic cardiomyopathy is associated with amelioration of symptoms and survival benefit. Percutaneous coronary intervention with stenting is associated with excellent outcome, high procedural success rate, low event rates, and can be safely performed in patients with ischaemic cardiomyopathy. Patients with complex coronary artery disease require surgical revascularization (Coronary Artery Bypass Grafting - CABG). Cardiac resynchronization therapy (CRT) aims to re-establishing synchronous contraction between the left ventricular free wall and the interventricular septum, resulting in an increase in stroke volume. In clinical terms, this is translated in functional class improvement. This generally involves biventricular pacing (pacing of the left and right ventricle through separate leads). Surgical strategy for the management of patients with end-stage ischaemic heart disease includes “conventional” techniques (surgical revascularization, the most common surgical procedure, surgical ventricular restoration in patient with a dyskinetic part in the left ventricle and mitral valve surgery for mitral regurgitation). Mechanical circulatory support aims to restore blood flow and pressure, and thus end-organ function, in patients with profound cardiogenic shock or in endstage patients (stage D) with advanced NYHA III-IV symptoms as a bridge to transplantation or as lifelong support (destination therapy). Heart transplantation is associated with excellent long-term results in terms of symptomatic relief and prognostic benefit under strict criteria involving the recipient and the donor. In the face of evolving technology, lifetime mechanical support provides a realistic alternative to heart transplantation.

Total Pages: 250-308 (59)

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