TREATMENT OF CHRONIC HEART FAILURE

Аннотация

Chronic heart failure (CHF) is one of the most severe and prognostically unfavorable complications of cardiovascular diseases. Over the past 30 years, the average life expectancy of patients with this diagnosis has increased from 3.5 to 8 years. This module contains information on modern CHF treatment options that a cardiologist should haveat all stages ofmedical care: from outpatient care toa heart failure specialist. Kеywоrds:chronic heart failure, treatment, high-tech treatment methods. INTRОDUСTIОN Chronic heart failure (CHF) is a disease with a complex of characteristic symptoms (shortness of breath, fatigue and decreased physical activity, edema, etc.), which are associated with inadequate perfusion of organs and tissues at rest or under stress and often with fluid retention in the body. The underlying cause is a deterioration in the heart's ability to fill or empty, caused by myocardial damage, as well as an imbalance of vasoconstrictor andvasodilating neurohumoral systems [1]. MАTЕRIАLSАND MЕTHОDS Ischemic heart disease isthe main cause of heart failure in2/3 ofall cases [2].This poses the problem of choosing approaches to myocardial revascularization in CHF for the clinician. Isolated left ventricular plastic surgery in patients with CHF of ischemic etiology with low left ventricular EF, despite a decrease in cardiac volume, did not affect the prognosis and cannot be considered recommended (class III, level of evidence B). The decision on the advisability of aneurysmectomy is made jointly by the surgeon and cardiologist; such intervention is justified in the case of large saccular aneurysms of the LV. The relevance of theproblem ofsurgical treatment of post-infarction aneurysms is due to the lowsurvival rate of patients: only 30-50% survive for 5 years, according to various authors (development of heart failure, thromboembolic complications, life-threatening rhythm disturbances in more than half of patients). Remodeling of the LV in post-infarction aneurysm is the appearance of akinesia zones, a decrease in stroke volume, an increase in the size and volume of the left ventricle, a compensatory increase in heart rate, and the occurrence of "ischemic mitral insufficiency". RЕSULTSАNDDISСUSSIОN Oneof the main problems inpatients with left ventricular systolicdysfunction is aortic valve stenosis with a low gradient (EF 40 mmHg, then there are no theoretical limitations for valve replacement in symptomatic patients. In patients with contraindications to open surgery (for example, due to severe lung pathology), it is possible to use transcatheter techniques for aortic valve replacement TAVI (Transcatheter aortic valveimplantation)[3]. Aortic valve repair or replacement is recommended for all symptomatic and asymptomatic patients with severe aortic regurgitation and EF 70 mm or end-systolic diameter >50 mm (or >25 mm/m2 of patient bodyarea)[4]. Evaluation of mitral regurgitation should be comprehensive, especially in patients with LV systolic dysfunction (in mitral regurgitation there are certain difficulties in assessing systolic function). Differential diagnosis between primary and secondary mitral regurgitation is complex. The decision to perform surgery should be based on the severity of clinical symptoms, patient age, atrial fibrillation, degree of left ventricular systolic function impairment, pulmonary hypertension, and the possibility of valve replacement. The latter is the most important predictor in the postoperative period. Relative (non-valvular) mitral regurgitation occurs due to dilation and change in the shape of the left ventricle and the mitral valve annulus, which leads to incomplete closure of its leaflets. Full-scale drug therapy and, in some cases, resynchronization therapy can lead to reverse left ventricular remodeling and a decrease in functional mitral regurgitation. depending onthearea of​ ​ mitral regurgitation. Ischemic mitral regurgitation is a special type of secondary mitral regurgitation that is most suitable for surgical intervention [2]. Combined surgical intervention – CABG + mitral valve replacement – ​ ​ can be considered appropriate in symptomatic patients with left ventricular dysfunction, coronary artery disease with a sufficient amount of viable myocardium. Predictors of late complications after mitral valve reconstruction are a large distance between the papillary muscles, rigidity of the posterior mitral valve leaflet and a ma