RESUMEN
The reduced availability of human donor hearts compared with the needs of patients with advanced heart failure refractory to medical therapy has promoted the search for therapeutic alternatives to cardiac allografts. Porcine heart xenotransplantation represents one of the most promising frontiers in this field today. From the first researches in the 1960s to today, the numerous advances achieved in the field of surgical techniques, genetic engineering and immunosuppression have made it possible at the beginning of 2022 to carry out the first swine-to-human heart transplant, attaining a survival of 2 months after surgery. The main intellectual and experimental stages that have marked the history of xenotransplantation, the latest acquisitions in terms of genetic editing, as well as the improvement of immunosuppressive therapy are discussed analytically in this article in order to illustrate the underlying complexity of this therapeutic model.
RESUMEN
OBJECTIVE: To compare efficacy and safety of indapamide-furosemide combination against metolazone-furosemide combination in refractory heart failure patients. METHODS: The randomised controlled trial was conducted at Rehman Medical Institute, Peshawar, Pakistan, from January 1 to June 30, 2018, and comprised refractory heart failure patients who were randomised into two groups using lottery method Group 1 received intravenous furosemide 40mg Q12hr with metolazone 5mg Q24hr, while group 2 received intravenous furosemide 40mg Q12hr with indapamide 2.5mg Q24hr. Both groups were assessed for urinary sodium excretion, total urine output and decrease in weight on day one, day three and day five of admission. SPSS 22 was used for data analysis. RESULTS: Of the 150 patients, there were 75(50%) in each of the two groups. Mean age in group 1 was 64.8}11.2 years, while it was 66.3}12.9 years in group 2. Both groups showed increased urinary sodium excretion and total urine output (p>0.05). Hypokalaemia was the most common adverse event 66%. Mean hospital stay was not significantly different between the groups (p>0.05). CONCLUSIONS: There was no significant differences between adverse events and efficacy between patients receiving either indapamide-furosemide combination or metolazone-furosemide combination.
Asunto(s)
Diuréticos , Furosemida , Insuficiencia Cardíaca/tratamiento farmacológico , Indapamida , Metolazona , Sodio/orina , Administración Intravenosa , Administración Oral , Anciano , Peso Corporal , Diuréticos/administración & dosificación , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Quimioterapia Combinada , Femenino , Furosemida/administración & dosificación , Furosemida/efectos adversos , Furosemida/uso terapéutico , Humanos , Indapamida/administración & dosificación , Indapamida/efectos adversos , Indapamida/uso terapéutico , Masculino , Metolazona/administración & dosificación , Metolazona/efectos adversos , Metolazona/uso terapéutico , Persona de Mediana Edad , PakistánRESUMEN
Although great progress has been made in the treatment of heart failure,refractory heart failure is still a difficult problem.It has high incidence and poor prognosis,which brings huge financial burden to patients, families and society. Recently,the clinical application of sacubitril/ valsartan and ivabradine,mechanical circulatory support,and heart transplantation have been greatly improved.This article reviews current treatments of refractory heart failure from aspects of new breakthroughs in drug treatment,mechanical circulatory support,and heart transplantation.