In the United States alone, more than 4.5 million people are affected by
heart failure, with more than 500,000 new cases diagnosed each year. Although
cardiac transplantation remains the "gold-standard" surgical treatment for
heart failure unresponsive to maximal medical
therapy, the chronic shortage of donor hearts has necessitated clinical trials of other surgical options. Over the past two decades, research, technological progress, and extensive clinical experience have resulted in the application of
ventricular assist device (VAD) technology to a broader population of
heart-failure patients, as these devices have proven to be viable therapeutic alternatives for
therapy of end-stage
heart failure. All patients undergoing
cardiac transplantation or VAD insertion have multiorgan dysfunction as a result of irreversible, severe
ventricular dysfunction resulting in
low cardiac output. Recently,
fenoldopam has been described as a
vasodilator that might be useful in patients with decompensated
heart failure, particularly in the perioperative setting. As a selective dopamine-1 receptor agonist,
fenoldopam causes vasodilation in the systemic, renal, mesenteric, coronary, and pulmonary vasculature. Potentially, the pharmacologic properties of
fenoldopam could be successfully exploited in patients undergoing medical or surgical treatment of end-stage
heart failure. Controlled randomized trials are needed to demonstrate improvement in cardiopulmonary or renal outcomes in such patients.