Hurdles to Cardioprotection in the Critically Ill
Critical Care Research Group, The Prince Charles Hospital, Chermside 4032, Australia
Faculty of Medicine, University of Queensland, Chermside 4032, Australia
Science and Engineering Faculty, Queensland University of Technology, Chermside 4032, Australia
School of Medical Science, Griffith University, Southport 4222, Australia
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Mol. Sci. 2019, 20(15), 3823; https://doi.org/10.3390/ijms20153823
Received: 5 July 2019 / Revised: 26 July 2019 / Accepted: 3 August 2019 / Published: 5 August 2019
(This article belongs to the Special Issue Positive and Negative Determinants of Ischaemic Injury—Co-Morbidities and Cardioprotection)
Cardiovascular disease is the largest contributor to worldwide mortality, and the deleterious impact of heart failure (HF) is projected to grow exponentially in the future. As heart transplantation (HTx) is the only effective treatment for end-stage HF, development of mechanical circulatory support (MCS) technology has unveiled additional therapeutic options for refractory cardiac disease. Unfortunately, despite both MCS and HTx being quintessential treatments for significant cardiac impairment, associated morbidity and mortality remain high. MCS technology continues to evolve, but is associated with numerous disturbances to cardiac function (e.g., oxidative damage, arrhythmias). Following MCS intervention, HTx is frequently the destination option for survival of critically ill cardiac patients. While effective, donor hearts are scarce, thus limiting HTx to few qualifying patients, and HTx remains correlated with substantial post-HTx complications. While MCS and HTx are vital to survival of critically ill cardiac patients, cardioprotective strategies to improve outcomes from these treatments are highly desirable. Accordingly, this review summarizes the current status of MCS and HTx in the clinic, and the associated cardiac complications inherent to these treatments. Furthermore, we detail current research being undertaken to improve cardiac outcomes following MCS/HTx, and important considerations for reducing the significant morbidity and mortality associated with these necessary treatment strategies.