Mechaniczne wspomaganie krążenia u chorych ze skrajną niewydolnością serca

Mechanical circulatory support (most often in the form of left ventricular assisst device [LVAD]) restores organ perfusion and function, improves functional status, quality of life and survival in patients with end-stage heart failure refractory to medical therapy. LVAD is currently used as a bridge-to-transplant, bridge-to-candidacy or bridge-to-recovery, and in patients with absolute contraindications to orthotropic heart transplantation (OHT), it may be the destination therapy. First generation pulsatile flow devices are currently implanted in a small percentage of patients. Second and third generation continuous flow devices are used in the majority of patients. They cause continuous organ perfusion, are more durable than pulsatile pumps, and because of the small size of the driving device, can be used in an outpatient setting and allow patients to live a normal life. Limitations of LVAD devices are hematological complications such as strokes and transient ischemic attacks, pump thrombosis, mucosal and gastrointestinal bleeding. In the perioperative period, these complications are a consequence of impaired liver function and heparinization during extracorporeal circulation. Later, they are primarily associated with the use of warfarin derivatives and antiplatelet drugs. Hemorrhagic complications are favored by the presence of acquired von Willebrandt syndrome caused by high shear stress associated with blood flow through the LVAD device. Furthermore infections, right ventricular failure and aortic regurgitation in patients treated with LVAD are observed. LVAD treatment is associated with many challenges and controversies, requires interdisciplinary knowledge and excellent surgical skills, necessitates constant monitoring of adverse events and systematic medical and psychological care of patients. Mechanical circulatory support represents a kind of revolution in cardiology and transplantology, increasing the chances for OHT by prolonging life and improving the functional status of patients on the heart transplant waiting list. The enormous technological progress observed in recent years, modern techniques of device implantation, and improvement in perioperative care have significantly improved the prognosis of patients after LVAD implantation.