Progress in cardiovascular diseases
-
The average age of patients undergoing cardiac surgery and the number of comorbidities they possess will continue to increase as surgical technology advances. Toxic/metabolic encephalopathy, hemispheric strokes, hypoxic injury, and peripheral nerve lesions all can occur as a result of cardiac surgery. Therefore, an understanding of the neurologic risk, recognizable syndromes, and preventative measures will continue to be important. Careful preoperative assessment, operative risk factor reduction, and careful postoperative assessments and management may reduce the neurologic risk for cardiac surgery.
-
Mechanical circulatory support has been shown to be of benefit to allow recovery after conventional heart surgery and as a successful bridge to heart transplantation. Recent clinical trials with implantable left ventricular assist devices (LVADs) have been completed with these devices showing restoration of normal hemodynamics and successful bridge to transplantation. A major advantage of the implantable devices is the ability for the patient to be discharged and followed up at an outpatient setting. ⋯ This article describes in detail the advantages and disadvantages of the extracorporeal devices as well as the operative techniques used to implant them. As the number of patients with heart failure continues to rise, so will the need for mechanical circulatory support. Though the majority of these patients will be served by a long-term implantable device, there will remain a subset of patients that will be best suited for treatment with extracorporeal devices.
-
Prog Cardiovasc Dis · Jul 2000
ReviewLeft ventricular assist device-induced reverse ventricular remodeling.
Left ventricular assist devices provide chronic pressure and volume unloading of the dilated left ventricle in patients with end-stage heart failure. This is associated with reverse structural remodeling (normalization of the passive pressure-volume relationship), reverse molecular remodeling (increased expression of several genes involved in calcium metabolism that are down-regulated in heart failure), improved baseline contractility, and improved contractile response to increased heart rate and to beta-agonist stimulation. These findings indicate the profound degree of recovery of myocardial properties in hearts previously considered to have invincible end-stage heart failure.
-
Prog Cardiovasc Dis · Jul 2000
ReviewOutpatient left ventricular assist device support: a safe and economical therapeutic option for heart failure.
The left ventricular assist device (LVAD), once considered for acute cardiac failure only when no other therapeutic option was available, is now used routinely at selected centers to allow the sickest patients to become self-sufficient and go home. This represents a dramatic change in the physician's perception of the LVAD in the early 1990s. The creation of these mechanical assist outpatient programs are possible for the following reasons: 1) confidence in the devices allow patients, their families, and health care providers to be more comfortable with outpatient therapy; 2) the devices are simplified and durable, allowing extended duration of support and more options for patients; and 3) a change in the perception of the LVAD from a last-resort therapeutic option to that of a safe and reliable bridge to recovery and transplant. ⋯ By using this construct, we have developed a successful outpatient LVAD program in which 70% of our vented electric LVAD patients were discharged with a 0% mortality and minimal morbidity. From our experience and studies, we believe that not only is an outpatient LVAD program safe and economical, but it is also socially, physically, and psychologically beneficial to the patient. In the current economic environment of cost containment, outpatient LVAD therapy is a necessary part of an LVAD program that should be sought by most cardiac mechanical assist programs.
-
Prog Cardiovasc Dis · Jul 2000
ReviewPerioperative management of the left ventricular assist device recipient.
An understanding of the unique preoperative, intraoperative, and postoperative considerations of left ventricular assist device implantation is essential for the successful anesthetic management of these challenging cases. This article discusses the different stages of anesthetic care of the left ventricular assist device recipient, including preoperative assessment, lining, induction, separation from cardiopulmonary bypass, and the postbypass period.