Publication: Importancia del ventrículo derecho en el paciente portador de un dispositivo de asistencia ventricular izquierda de flujo continuo de larga duración
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2023-04-14
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Universidad Complutense de Madrid
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Abstract
El dispositivo de asistencia ventricular para soporte del ventrículo izquierdo (DAVI) es una terapia consolidada para el tratamiento de la insuficiencia cardiaca con fracción de eyección del ventrículo izquierdo reducida (HFrEF).Una adecuada función del ventrículo derecho (VD) es un aspecto fundamental a la hora de identificar a los candidatos que más se pueden beneficiar del implante de un DAVI, además de ser un requisito para el éxito a corto y medio plazo tras el implante del DAVI de larga duración. Los problemas relacionados con el fracaso del VD tras el implante de un DAVI impactan deforma negativa sobre la calidad de vida, las hospitalizaciones y la supervivencia. Actualmente disponemos de herramientas para identificar y optimizar a los candidatos con mayor riesgo de presentar un fracaso agudo del VD tras el implante pero la evidencia científica se centra en cohortes con perfil de riesgo preoperatorio alto. Durante los últimos años se discute sobre una forma de fracaso tardío del VD después de la implantación del DAVI. Se cree que esta complicación puede tener un impacto negativo en la calidad de vida y la supervivencia de los pacientes. Sin embargo el conocimiento sobre su incidencia, el tiempo de aparición tras la implantación del DAVI o los factores de riesgo relacionados con su aparición en la nueva era del DAVI de flujo continuo es escaso...
Left ventricular assist device (LVAD) therapy is well established in the treatment of advanced heart failure with reduced left ventricular ejection fraction (HFrEF) and LVAD implants have grown exponentially in recent years. This has allowed significant progress in the implementation of improvements in technique and device durability and has contributed to a slow but steady decrease in hemocompatibility-related adverse events. An appropriate right ventricular function is crucial both during the identification of LVAD candidates and to ensure a short- and long-term post-implantation success. Problems related to right ventricular (RV) failure after LVAD implantation have a negative impact on quality of life, hospitalizations and survival. We currently rely on screening methods to identify and optimize candidates at risk for this complication. However, the scientific evidence focuses on cohorts with a high preoperative risk profile. This fact contrasts with the moving clinical profile of LVAD candidates, to more stable clinical scenarios and a trend toward more elective implants in less ill patients. Many of these patients suffer from chronic RV failure that is intimately associated with the time course of HFrEF, which may play an important role in the pathophysiology of RV failure after LVAD...
Left ventricular assist device (LVAD) therapy is well established in the treatment of advanced heart failure with reduced left ventricular ejection fraction (HFrEF) and LVAD implants have grown exponentially in recent years. This has allowed significant progress in the implementation of improvements in technique and device durability and has contributed to a slow but steady decrease in hemocompatibility-related adverse events. An appropriate right ventricular function is crucial both during the identification of LVAD candidates and to ensure a short- and long-term post-implantation success. Problems related to right ventricular (RV) failure after LVAD implantation have a negative impact on quality of life, hospitalizations and survival. We currently rely on screening methods to identify and optimize candidates at risk for this complication. However, the scientific evidence focuses on cohorts with a high preoperative risk profile. This fact contrasts with the moving clinical profile of LVAD candidates, to more stable clinical scenarios and a trend toward more elective implants in less ill patients. Many of these patients suffer from chronic RV failure that is intimately associated with the time course of HFrEF, which may play an important role in the pathophysiology of RV failure after LVAD...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 04-07-2022