The Cardiovascular Department at Niguarda Ca Granda Hospital (HONIG) in Milan is a tertiary
care referral centre that offers all advanced treatment options for the care of advanced chronic heart
failure (ACHF) patients. The Heart Transplant/ Heart Failure Program is managed by the II
Cardiology Division, and carries out clinical management of ACHF patients, selection and
treatment of candidates on the heart transplant (HTx) waiting list and follow-up of transplanted
patients, with a 20-bed unit. The Cardiac Surgery Division performs HTx, mechanical assist device
implants, both as bridge-to-HTx and destination therapy, and extreme surgery, revascularization and
ventricular restoration, for HF. Since 1985 and 1988 respectively, 786 patients have received an
HTx and 110 a total or partial artificial heart at HONIG. During 2007-2008 25 VAD were
implanted in 21 patients (14 bridge-to-HTx, 3 destination therapy, 4 bridge-to-recovery) for an
average of 101 days support. Survival was 13/21 (62%), with 9 patients discharged home for long-
term support surviving (75%).

Currently, over 500 transplant recipients and 700 ACHF patients are followed-up by the Heart
Transplant/Heart Failure Cardiology Unit. A day-hospital or outpatient service manages patients
with VAD or ACHF on continuous or intermittent inotrope infusion and takes part in the Regione
Lombardia telemonitoring program for HF patients. The CN R Clinical Physiology Institute (IFC)
of Milan is a part of HONIG, and fully supports the Heart Transplant/ Heart Failure Program by
coupling to this extensive clinical competence, research expertise and activities centered on the role
of cardiac imaging and biomarkers as predictive tools for ACHF.

HONIG is the Italian hospital with the largest experience in mechanical assist devices (VAD) in
heart failure. There is an established cooperation between cardiac surgeons, heart failure
cardiologists, and intensive care staff, in order to optimize pt and device selection and postoperative
management. The skill in patient care in the setting of chronic heart failure by the medical and nurse
staff of the cardiology unit covers both long-term follow-up of VAD pts and
telemedicine/telemonitoring of advanced heart failure. Different devices has been employed
according to pt conditions, in the acute contex t and in chronic patients, as a bridge to transplantation
or as destination therapy. Recovery has been observed in acute cardiogenic shock and occasionally
in chronic heart failure. The Center has published various papers regarding its experience in
advanced heart failure and VAD therapy.

HONIG and CNR are partners in the VPH2 project (FP7 ICT-2007), funded by the EU, to develop a
decision support system for management of patients with post-ischemic left ventricular dysfunction.

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