Deactivation of Left Ventricular Assist Devices at the End of Life: Narrative Review and Ethical Framework.
JACC Heart Fail
; 11(11): 1481-1490, 2023 11.
Article
em En
| MEDLINE
| ID: mdl-37768252
ABSTRACT
Left ventricular assist devices (LVADs) have become an increasingly common advanced therapy in patients with severe symptomatic heart failure. Their unique nature in prolonging life through incorporation into the circulatory system raises ethical questions regarding patient identity and values, device ontology, and treatment categorization; approaching requests for LVAD deactivation requires consideration of these factors, among others. To that end, clinicians would benefit from a deeper understanding of 1) the history and nature of LVADs; 2) the wider context of device deactivation and associated ethical considerations; and 3) an introductory framework incorporating best practices in requests for LVAD deactivation (specifically in controversial situations without obvious medical or device-related complications). In such decisions, heart failure teams can safeguard patient preferences without compromising ethical practice through more explicit advance care planning before LVAD implantation, early integration of hospice and palliative medicine specialists (maintained throughout the disease process), and further research interrogating behaviors and attitudes related to LVAD deactivation.
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Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Coração Auxiliar
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Cuidados Paliativos na Terminalidade da Vida
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Planejamento Antecipado de Cuidados
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Insuficiência Cardíaca
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article