Bijzondere interventies aan het hart - Gezondheidsraad

Meanwhile, it has also been found that heart-valve deficiencies can be successfully
treated using percutaneous techniques, such as valve dilatation or a procedure
to correct mitral valve leakage. However, this palliative treatment should
still be seen as experimental. The same applies to percutaneous aortic valve
implantation.
On average, as a result of all these developments, heart valve procedures
have become increasingly complex and potentially risky. This demands a multidisciplinary
approach by surgeons and cardiologists. This can best be guaranteed
in fully integrated centres. To this end, the current permit policy is an effective
instrument.
Treatment of heart failure
Chronic heart failure is a disorder of an aging population. The average age at
which individuals are diagnosed with this condition is currently 65 years. The
number of patients diagnosed with the clinical syndrome of heart failure is rapidly
increasing. This is a product both of the aging of the population and of the
increased success of treatments which results in better survival. This is a major
(and expensive) public health problem that merits greater consideration. The
government should also take note.
Heart failure can result from a range of heart diseases. The course of this disease
can be divided into various stages, each of which requires a suitably tailored
treatment strategy. In this connection, it is important to adopt a structured treatment
plan in which the cardiologist and the surgeon consult one another regarding
the best approach in a particular case. Particularly in the later stages of heart
failure, special interventions such as ICD implantation and cardiac resynchronisation
therapy (CRT) can be considered, as a protection against sudden death. At
this point, surgical procedures such as CABG, reconstruction of the left ventricle,
and the surgical correction of a mitral valve leakage may also be indicated.
In the final stage of heart failure, when patients have a very short life expectancy,
a heart transplant is a highly effective and life-prolonging procedure. However,
the limited availability of donor hearts means that this approach can only be
used in a very limited number of cases. Nevertheless, it is now possible to bridge
the waiting period involved by using a left ventricular assist device. These LVAD
systems can also be used for a small group of selected patients as a bridge-torecovery,
enabling their own heart to heal. It can also be used as a definitive therapy
in patients who are not eligible for heart transplant surgery (destination therapy).
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