Importancia del ventrículo derecho en el paciente portador de un dispositivo de asistencia ventricular izquierda de flujo continuo de larga duración

Abstract

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...