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Dispositivos mecánicos de apoyo circulatorio para la insuficiencia ventricular derecha aguda
Navin K Kapur1, Michele L Esposito2, Yousef Bader2
1From The Cardiovascular Center, Tufts Medical Center, Boston, MA (N.K.K., M.L.E., Y.B., K.J.M., M.S.K.); Department of Cardiac Surgery, Northwestern University Medical Center, Chicago, IL (D.T.P.); and Cardiovascular Research Foundation, New York, NY (D.B.). nkapur@tuftsmedicalcenter.org.
Circulation
|July 19, 2017
Resumen
La insuficiencia ventricular derecha es una causa significativa de muerte. Las bombas de apoyo circulatorio mecánico agudo ofrecen una opción vital para estabilizar a los pacientes con insuficiencia de RV y choque cardiogénico.
Área de la Ciencia:
- Cardiología
- Cirugía cardiovascular
- Ingeniería biomédica
Sus antecedentes:
- La insuficiencia ventricular derecha es un determinante crítico de la morbilidad y la mortalidad en la insuficiencia cardíaca avanzada, la hipertensión pulmonar y la cirugía post-cardiaca.
- Los dispositivos de apoyo circulatorio mecánico agudo (RV MCS) administrados por vía percutánea han surgido como una opción terapéutica clave en las últimas dos décadas.
- RV MCS juega un papel crucial en la estabilización de los pacientes que experimentan un shock cardiogénico que involucra el RV.
Objetivo del estudio:
- Para revisar la fisiopatología del fallo agudo del RV.
- Discutir los mecanismos de acción y la utilidad clínica de los dispositivos RV MCS actuales.
- Para resaltar el papel en evolución de RV MCS en el manejo de pacientes.
Principales métodos:
- Revisión de la literatura sobre los dispositivos de apoyo circulatorio mecánico agudo RV existentes.
- Análisis de los datos clínicos sobre la eficacia y la aplicación de RV MCS.
- Discusión de la fisiopatología del fallo agudo de RV.
Principales resultados:
- El apoyo circulatorio mecánico agudo de RV es una intervención establecida para la falla de RV.
- La efectividad de RV MCS depende cada vez más de la selección optimizada de pacientes, el monitoreo y los protocolos de destete.
- Los dispositivos MCS RV existentes ofrecen una estabilización rápida para el choque cardiogénico RV.
Conclusiones:
- RV MCS es una parte integral de la gestión de fallas de RV.
- Los avances futuros en RV MCS se centrarán en estrategias mejoradas de manejo de pacientes más allá de la implantación técnica.
- La optimización de algoritmos para la identificación de fallas de RV, el monitoreo de pacientes y los protocolos de destete es esencial para maximizar el beneficio de RV MCS.
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