Treatment challenges in end-stage heart failure

This thesis explores various aspects of end-stage heart failure treatment, focusing on the effectiveness and safety of therapies and the impact of mechanical support in patients with end-stage heart failure. The first review assesses the safety and benefits of intermittent levosimendan infusions, showing improvements in heart function and quality of life without significant differences in mortality. Further studies are focused on circulatory mechanical support. The relationship between infections and strokes in patients with Left Ventricular Assist Devices (LVADs) is investigated, revealing an increased risk of cerebrovascular accidents in patients with infections. These findings highlight the importance of careful anticoagulation management and infection control.

Subsequent studies examine the technical and surgical aspects of LVAD support, such as the influence of inflow cannula positioning on alarm signals, outflow graft angles on thromboembolic events, and mechanical malfunctions in the newer generations LVADs. The importance of correct placement and continuous technical evaluation is emphasized to minimize complications. Additionally, the effects of anatomical variations and chest-wall abnormalities are investigated. Furthermore, the outcomes of heart transplantations are explored, with the evolution of tricuspid valve regurgitation over time, revealing the need for long-term observation and follow-up to improve patient outcomes. Finally, the thesis compares biatrial and bicaval transplantation techniques, with the bicaval technique showing superior early and long-term outcomes.