RESUMEN
Ventricular assist devices (VADs) have become an established therapeutic option for patients with end-stage heart failure. Achieving the potential for recovery of native heart function using VADs is an established form of treatment in a selected group of patients with HF. We report two cases of VAD patients with different types of pump used for mechanical circulatory support, a continuous flow pump (Heart-Ware(®)) and a pulsatile pump (POLVAD MEV(®)), which allow regeneration of the native heart. Patients were qualified as INTERMACS level 3-4 for elective implantation of an LVAD. Implantations were performed without complications. The postoperative course was uncomplicated. In the HeartWare patient the follow-up was complicated by episodes of epistaxis and recurrent GIB as well as driveline infection. The follow-up of the POLVAD MEV patient was uneventful. Recurrent GIB forced us to withdraw aspirin and warfarin therapy and maintain only clopidogrel in the HeartWare patient.. In mid-February 2013 the patient was admitted due to dysfunction of the centrifugal pump with a continuous low-flow alarm and increase power consumption. Under close monitoring of the patient a decision was made to stop the pump immediately and evaluate cardiac function. The serial echocardiography studies showed significant improvement in LVEF up to 45% and no significant valvular pathology. In February 2013 LVAD explant was performed by left thoracotomy without complications. At six-month follow-up the patient was in a good clinical condition, in NYHA class I/II, and on pharmacological treatment.
Asunto(s)
Estenosis de la Válvula Aórtica/terapia , Bioprótesis/efectos adversos , Cateterismo Cardíaco/métodos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas/efectos adversos , Anciano , Estenosis de la Válvula Aórtica/etiología , Axila , Cateterismo Cardíaco/instrumentación , Angiografía Coronaria , Femenino , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Polonia , Falla de Prótesis , Reoperación , Resultado del TratamientoRESUMEN
INTRODUCTION: The no-reperfusion phenomenon occurs in a considerable number of patients despite restoration of the infarct-related artery (IRA) patency. Factors responsible for this phenomenon include myocardial structural changes, whereas haemorheological parameters that significantly contribute to microvascular resistance, have not been studied so far. AIM: To determine the possible relationship between blood and plasma viscosity, red blood cell aggregation and their deformability, and myocardial reperfusion following effective mechanical intervention of IRA. METHODS: The analysis included 23 patients with myocardial infarction treated with primary coronary angioplasty with resultant TIMI (Thrombolysis in Myocardial Infarction) grade 3 flow. Myocardial reperfusion was found effective if myocardial perfusion grade (MPG) was 3. Blood and plasma viscosity were assessed using a Brookfield rotation viscometer. Red blood cell aggregation and deformability were measured with a Laser Optical Rotational Cell Analyzer (LORCA). Patients were divided into two groups with respect to obtained MPG: reperfusion group (14 subjects) and no-reperfusion group (9 patients). RESULTS: Corrected whole blood viscosity and plasma viscosity were significantly higher in the no-reperfusion group and exceeded the values obtained in the reperfused patients by 14% (p <0.05) and 10.5% (p <0.01), respectively. Red blood cell deformability index at shear stress ranging from 1.75 Pa to 60.03 Pa was significantly lower in the no-reperfusion group. Red blood cell aggregation index was significantly higher (by 14.3%, p <0.05), whereas aggregation halftime was significantly shorter (by 58%, p <0.05) in the no-reperfusion group. CONCLUSIONS: Our results indicate that haemorheological disturbances may be an important factor contributing to no-reperfusion after effective mechanical opening of IRA.