Hao A. Tran

Potential new drug treatments for congestive heart failure

ABSTRACT Introduction: The prevalence of heart failure (HF) has increased globally in recent decades. Advances in our understanding of underlying pathophysiologic mechanisms have given rise to new therapies for treating the growing HF population. Nonetheless, morbidity and mortality associated with HF and its financial implications are daunting. Thus, novel therapies that can improve the natural history of HF patients are urgently needed. Areas covered: This article reviews new investigational drugs being developed for the treatment of both acute decompensated heart failure (ADHF) and chronic heart failure with reduced ejection fraction (HFrEF). It presents the background of these drugs with a focus on their mechanism of action, their pharmacology, evidence from clinical studies and their potential role in HF management. Expert opinion: The mortality benefit associated with serelaxin treatment in the RELAX-HF trial is being tested in RELAX-AHF II, while two other drugs, ularitide and TRV027, are also being evaluated in ADHF patients. Two new agents for the treatment of chronic HFrEF, LCZ696 and ivabradine, have been recently been approved for use by the FDA and four novel agents which have shown considerable promise in early studies, omecamtiv mecarbil, vericiguat, finerenone, and neuregulin, are currently being evaluated in late-phase clinical trials.

A Case Series of Biventricular Circulatory Support Using Two Ventricular Assist Devices: A Novel Operative Approach

Increased use of continuous-flow left ventricular assist devices (LVADs) to treat advanced heart failure has heightened concern for right ventricular failure after LVAD implantation, which is associated with increased morbidity and mortality. Biventricular support is required in up to 30% of LVAD recipients. Currently, no durable long-term right ventricular assist device (RVAD) has been approved other than the Syncardia (Tucson, AZ) total artificial heart. A recent publication reported the placement of continuous flow LVAD in the heavily trabeculated right ventricle; however, this orientation may jeopardize both assist device and right ventricle function. We describe three cases of right-sided mechanical circulatory support with durable RVAD implanted in the right atrium, allowing long-term support with fewer anatomic limitations as compared with right ventricular cannulation.

Garbage In, Gospel Out Ignoring Goals of Care When Assessing Heart Failure Quality Metrics

former 2 groups were based on timing of DNR orders with the designation either at admission or transitioned from full resuscitative care to DNR status, respectively. Outcomes were stratified based on CMS-endorsed risk adjustment models primarily including 30-day mortality, hospital readmissions, and death within 30 days of discharge. Finally, hospitals were separated into quintiles based on achievement of heart failure performance measures and results were then pared to include/exclude DNR orders. Roughly one quarter of patients had DNR orders at some point during the index hospitalization (15% on admission and 11% switched from full code at a later time). The 30-day mortality was 27%, 35%, and 3% for those with admission DNR, later DNR, and full code designations, respectively. Moreover, compared with patients with full resuscitative wishes, patients with the DNR orders tend to have a higher rate of death during index

Successful ventricular tachycardia ablation in a patient with a biventricular ventricular assist device and heparin-induced thrombocytopenia using bivalirudin

Author(s): Ho, Gordon; Tran, Hao A; Urey, Marcus A; Adler, Eric D; Pretorius, Victor G; Hsu, Jonathan C

Original InvestigationEditorial CommentOften Talked About, Seldom Seen: Promoting Myocardial Recovery With Ventricular Assist Device∗

Ventricular assist devices (VADs) have fundamentally changed the treatment of end-stage heart failure. However, despite great advances, long-term VAD use is still associated with frequent hospitalizations, serious complications, and a 2-year survival of approximately 70% [(1)][1]. Although

Often talked about, seldom seen: promoting myocardial recovery with ventricular assist device.

Ventricular assist devices (VADs) have fundamentally changed the treatment of end-stage heart failure. However, despite great advances, long-term VAD use is still associated with frequent hospitalizations, serious complications, and a 2-year survival of approximately 70% [(1)][1]. Although