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Systolic heart failure

diagnosis and therapy

Henes, Janek; Rosenberger, Peter

Current Opinion in Anesthesiology: February 2016 - Volume 29 - Issue 1 - p 55–60
doi: 10.1097/ACO.0000000000000270
CARDIOVASCULAR ANESTHESIA: Edited by Alexander Zarbock
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Purpose of review The present review highlights recent findings on perioperative systolic heart failure. It briefly summarizes the pathophysiology of heart failure and provides the reader with new insight in diagnosis and treatment of systolic heart failure. In addition, we review new therapeutic strategies with pharmacologic agents and mechanical assist devices to treat systolic heart failure.

Recent findings Left ventricular systolic heart failure is a high-risk disease for patients undergoing cardiac and noncardiac surgery and poses a high burden on the anesthesiologist in charge. Perioperative echocardiography is well established for urgent diagnosis in the operating room and is superior to biomarker-based diagnosis. Although cardiovascular disease associated mortality decreases, systolic heart failure related mortality remains at a high of 50% after 5 years. As a consequence, left ventricular assist device implantation rates grow rapidly and include approximately 30–40% patients with desperate clinical situation and destination therapy. Extracorporeal life support for acute heart failure needs further investigation to document possible indications and side-effects.

Summary Recent advances in the field of cardiovascular anesthesiology comprise advanced use of perioperative echocardiography, mechanical circulatory assist devices, and customized pharmacologic management.

Department of Anesthesiology and Intensive Care Medicine, Tübingen University Hospital, Tübingen, Germany

Correspondence to Janek Henes, MD, Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Hoppe-Seyler-Straße 3, D-72076 Tübingen, Germany. Tel: +49 7071 2981110; e-mail: janek.henes@uni-tuebingen.de

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