RESUMEN
The surgical options for CHF are a part of a larger paradigm shift in management. Viable and effective surgical options other than cardiac transplant and ventricular assist devices clearly exist and are applicable to a large portion of patients with CHF. These surgical therapies are of acceptable risk before decompensated CHF develops. The rapidly evolving therapies for altering LV remodeling, which underlies CHF progression, are an exciting area that may be joined in the future by molecular advances in myoblast transfer and gene therapy. These therapies are the basis of the discipline of CHF surgery within cardiovascular surgery.
Asunto(s)
Insuficiencia Cardíaca/cirugía , Cardiomiopatía Dilatada/complicaciones , Cardiomioplastia , Puente de Arteria Coronaria , Insuficiencia Cardíaca/complicaciones , Ventrículos Cardíacos/cirugía , Humanos , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/cirugía , Pronóstico , Volumen Sistólico , Resultado del Tratamiento , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Izquierda/cirugíaRESUMEN
The use of the left ventricular assist device as a bridge to recovery represents a new phenomenon. This article focuses on bridge-to-recovery in the settings of myocarditis and dilated cardiomyopathy with a review of the hemodynamic, neurohormonal, physiologic, cellular, and molecular changes of recovery during left ventricular assist device support. Despite numerous markers of success, there is a disconnect from the limited clinical successes that are reviewed. The current status and future options to increase the chances of success are highlighted.
Asunto(s)
Cardiomiopatía Dilatada/cirugía , Corazón Auxiliar , Miocarditis/cirugía , Recuperación de la Función , Adulto , Femenino , Predicción , Corazón Auxiliar/tendencias , Hemodinámica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A new application for left ventricular assist devices (LVAD) is as a bridge to recovery. In the settings of myocarditis and dilated cardiomyopathy, LVAD support is accompanied by marked hemodynamic, neurohormonal, physiologic, cellular, and molecular changes indicative of recovery. Despite these changes, experience with clinical successes is limited. Further studies of topics such as the timing of LVAD implantation and explantation, adjunct medical and surgical therapy, and optimum LVAD weaning protocols might help improve the success of this promising technology.