TY - CHAP M1 - Book, Section TI - Cardiac Transplantation and Prolonged Assisted Circulation A1 - Mehra, Mandeep R. A2 - Jameson, J. Larry A2 - Fauci, Anthony S. A2 - Kasper, Dennis L. A2 - Hauser, Stephen L. A2 - Longo, Dan L. A2 - Loscalzo, Joseph PY - 2018 T2 - Harrison's Principles of Internal Medicine, 20e AB - Advanced heart failure, a distinct syndrome, is characterized by refractoriness to conventional therapy and represents a vexing clinical dilemma that is associated with an increased symptom burden, frequent hospitalization, a poor quality of life and high risk of death. Such individuals do not tolerate neurohormonal antagonists at recommended doses, exhibit cardiorenal syndrome, maintain markedly poor cardiac reserve on cardiopulmonary stress testing, and typically display a low cardiac output state with elevated pulmonary pressures. In general, therapeutic targets shift away from disease modifying neurohormonal therapy to surgical options that attend directly to the myocardial stress and strain relationship. Most often, prolonged circulatory assistance using mechanical pumps or cardiac transplantation is required to reliably improve quality of life and long-term survival. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1156562770 ER -