About this Research Topic

Background

Heart failure is at the center stage of cardiology. With breakthrough device and medical treatment options having emerged over the last two decades, the therapeutic armamentarium led to a relevant improvement in symptoms and prognosis. On the other hand, with rising incidences in an ageing society, end-stage treatment options are becoming increasingly needed. Such treatment options as heart transplantation, long-term ventricular assist device (LVAD) therapies and in selected cases prolonged inotropic support, are available, although their access and use extremely vary worldwide. Since no universal guideline exists for patient selection for LVAD therapy or heart transplantation and INTERMACS profiles or VO2 max alone are likely insufficient to quantify a patient’s risk, other factors must be taken into consideration. Such factors include secondary organ function, frailty as well as resilience, gender-based differences and concomitant procedures, together with an assessment and personalized treatment approach per patient. Additionally, intersectoral boundaries often obstruct optimal treatments. Furthermore, even in patients who received a timely transplantation or LVAD implantation, long-term obstacles and patient centered outcomes of these therapies are underrepresented in contemporary literature.

The first goal of this research topic is to globally compare the access and evaluation approaches of patients for end-stage heart failure therapies and to guide a direction to overcome different (e.g. intersectoral) boundaries. A focus will be placed on displaying treatment options or combinations thereof that are newly established or have gained focus (e.g. LVAD implantation for short-term mechanical circulatory support or heart transplantation after short-term mechanical circulatory support, with respect to adjusted allocation criteria and a more personalized treatment approach, e.g. with respect to gender and frailty).

The second goal of this research topic is to display long-term outcomes in different patient cohorts and disease phenotypes, importantly with a focus on clinically relevant consequences in respect to both key therapeutic options; heart transplantation and LVAD implantation.

This covers:
1) Longevity by preventing and treating cellular or humoral rejection, cardiac allograft vasculopathy, infections after heart transplantation.
2) Hemocompatibility problems, infections and (late) right heart failure after LVAD implantation
3) Quality of life and symptom relief together with costs and burden of care.

Keywords: Mechanical circulatory support, LVAD, Heart transplantation, Long-term outcome, Pump thrombosis, Cardiac allograft vasculopathy, Right heart failure, Cellular rejection, Humoral rejection, Hemocompatibility, Heart failure

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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