Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure

Cardiovascular diseases are the leading cause of serious illness and death in
the world. In 1948, the Framingham Heart Study embarked on an ambitious
health research project. At that time little was known about the general causes
of heart disease and stroke, but the deaths caused by these diseases had been
steadily increasing since the beginning of the century and had become an
American epidemic.
The objetive of the Framingham Heart Study was to identify factors or
characteristics that contribute to cardiovascular disease by closely observing
the development of these diseases over a long period of time and with a large
group of participants who did not have any significant symptoms of these
diseases, Nor suffered a heart attack or stroke.
Heart failure (HF) is a disease with acute and chronic forms that can progress
slowly from asymptomatic left ventricular dysfunction to a state of marked
disability.
The functional limitations that the disease is imposing have an unfavorable
impact on the productive capacity of those affected.
There is marked disturbance of the quality of life. This means that from the point
of view of public health the disease causes economic burdens of repeated
hospitalizations and medical attention, to which must be added the lack of
production.
When we talk about advanced heart failure we are referring to a syndrome
characterized by major limitations in the patient's survival, functional status and
quality of life.
Currently there are a variety of therapies to help improve the patients who are
affected by this pathology, however the above factors are seriously affected
despite giving the treatments with better results based on the evidence.
Currently one of the therapies used for the treatment of this disease are left
ventricular assist devices that provide patients with a therapeutic option which
provides circulatory support while they are waiting for a heart transplant or even
on many occasions ask Serve as an alternative to transplantation.
Different studies have been carried out to evaluate the efficacy and safety of the
devices used for the treatment of this disease since to be talking about using
technology that is relatively new in our environment must be guaranteed that it
is really effective in terms of Objectives that we are seeking to achieve in order
to give the patient a real advantage over the disease
One of the main objectives of the devices is to help the patient in a global
manner, this includes reducing as much as possible the presence of
complications of the use of the devices, so much so that changes must be
made during use Of the device to ensure that the treatment is a therapeutic
measure and not a point more against the health of the patient, the scale
parameter for the model depended on the device as a fixed effect and in the
device and analysis site combinations as effects Of random interaction in the
comparisons between the study group and the control group.
This focusing on the complications of the same disease are already quite
harmful to the health of the patient, therefore we must take into account the
seriousness of the complications that may occur during use and treatment with
the device as they have an important implicacon In the health of those involved
in such treatment, such as higher rates of bleeding, cardiac arrhythmias, renal
dysfunction and infections. When applying these devices we have to use
different scales to assess the progression of the impact they have on the
evolution of the disease
Being modern devices we can achieve a great advance in the benefits granted
towards the patient nevertheless we must take into account that many of them
did not present the expected improvement and could even see a delay on the
clinical improvement of the disease, speaking specifically Of the left ventricular
assist device the functional status and quality of life of the patients improved in
many up to about 80%, however Participants who received the control device
were more likely to require device replacement, explantation, or urgent
transplant. The study device was associated with more strokes, right heart
failure and sepsis. Treatment with either device was associated with sustained
improvements in functional and quality of life measures.
The greatest number of strokes occurred within the first 6 months. In a post-
implantation analysis, it was observed that an average blood pressure of more
than 90 mm Hg was associated with a risk of stroke. The data obtained are
consistent with the assessments already made of the centrifugal flow device, in
which an association between high blood pressure and stroke was found.
These findings suggest that management strategies, including early
postoperative management, can positively influence the presence or absence
of complications.
At the end of this type of studies, we can realize that the technology with which
it is currently available is a great help for a better control of chronic-
degenerative diseases and because there are different options as to the
equipment that could be used, We can better adapt to the clinical presentation
of the disease to find the best therapeutic option and thus improve the quality
and life expectancy of patients.