Mechanical Circulatory Support: LVAD in Heart Failure
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Advanced heart failure is a serious medical condition with a poor prognosis despite optimal medical management. Heart transplantation remains the gold standard for the treatment of advanced heart failure, but it is severely limited by chronic donor shortage. In such scenario, contemporary continuous flow LVAD is emerging as an alternative to transplant in very selected patients. A thorough evaluation of the right ventricular function is mandatory before implantation because the device will support only the left ventricle. Survival is 80 and 70% at 1 and 2 years after LVAD implantation, respectively. During support, patients experience a significant improvement in functional status and quality of life, even if it is still inferior when compared to heart transplantation. LVAD also allows the treatment of severe reversible pulmonary hypertension, decreasing the risk of the transplantation. Most frequent complications observed during support are bleeding and infection. LVAD thrombosis, albeit much less frequent, is a life-threatening event that can lead to pump stop and even death. Treatment options for thrombosis are thrombolytic therapy, LVAD replacement, and urgent transplantation.
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