18^th Annual Cardiologists Conference

Heart failure has a rapidly increasing incidence in both men and women and is the most prominent heart disease in the elderly. This is due to the successful treatment of acute heart disease which later on turns into chronic failure. Whereas pharmaceutical and electrophysiological concepts have been constantly improved, end-stage heart failure has been approached by various surgical procedures.

The majority of cases depends on ischemic heart disease which we described as LOCIMAN (Left heart failure, Occlusion of the Coronary artery, Incompetence of Mitral valve and Left ventricular Aneurysm or Akinesia). It appears to be mandatory to evaluate the relative contribution of these components to heart failure and the relative importance of surgical procedures (coronary bypass, mitral valve repair and aneurysmectomy) for cardiac improvement.

These procedures play a major role in less than profound heart failure. In such cases, various external support procedures were introduced which mostly have been abandoned as well as the partial ventricular resection procedure (Batista).

Neither external restraint procedures have not fulfilled the expectations nor myocardial regeneration and stem cell application.

Heart transplantation is now a well-established treatment for end-stage heart failure, enabling a high degree of physical rehabilitation and a mean survival time of 12 to 14 years. Some of our patients are now living for more than 30 years after transplantation. However, heart transplantation is an option offered to only few patients due to limited availability of donor organs.

Mechanical circulatory support systems have achieved clinical application during the last 30 years. Between 1987 and 2014, more than 2300 ventricular assist devices have been implanted in Berlin to keep patients alive, after which there were three options: bridge to transplantation, bridge to myocardial recovery in myocarditis and in cardiomyopathy, first demonstrated by pump explantation and long-term stability in Berlin in 1995, and as permanent implants.

Originally these ventricular assist devices were extracoporeal connected to large driving units. Thereafter, electrical pulsatile systems were introduced; however, these were noisy and bulky. In 1998, the author implanted the first rotary blood pump with continuous flow (MicroMed DeBakey) worldwide. Such systems, which are small and silent, have become the standard in now 90% of cases. These pumps also qualify for long-term use (up to 10 years). They are developed to support the left ventricle; however, they can be also implanted in the right ventricle when necessary. Moreover these systems are very useful in elderly patients.

Pulsatile extracorporeal systems, i.e. Berlin Heart EXCOR Pediatric, are the only one available for end-stage heart failure in infants and young children.

Complete myocardial recovery has been observed with ventricular assist device support in acute myocarditis and even in dilative cardiomyopathy.