Značaj funkcije desne srčane komore za ishod lečenja i remodelovanje srca nakon LVAD implantacije

  • Dusko Terzic
DOI: https://doi.org/10.5937/mp73-38192
Ključne reči: LVAD, desna komora, remodelovanje srca

Sažetak


Efikasnost uređaja za trajnu cirkulatornu potporu leve komore dokazana je kroz kliničku praksu uz trend konstantnog poboljšanja rezultata lečenja sa biotehnološkim napretkom i unapređenjem hirurških tehnika ugradnje. Publikovani izveštaji većine referentnih kardiohirurških centara prezentuju jednogodišnju stopu preživljavanja od preko 85%, dvogodišnju stopu od 70% i petogodišnju stopu preživljavanja od 45-50%. Pored jasnih benefita za bolesnika LVAD implantacija nosi i značajne specifične rizike ,pa su  infekcije, krvarenja posle implantacije  , mozdani udari i postimplantaciona slabost desne komore najcesce komplikacije . Obzirom da je napredak LVAD programa obezbeđen , pre svega, smanjenjem incidence komplikacija koje nisu  vezane za funkcionisanje pojedinačnih segmenata kardiovaskularnog sistema, a kako je funkcija leve komore potpuno zamenjena LVAD uređajem  najaktuelniji izazov predstavlja odluka o ugradnji LVAD uređaja u srce sa oslabljenom funkcijom desne komore obzirom da je postimplantaciona slabost desne srčene komore povezana sa dokazano povećanim mortalitetom i morbiditetom. Već od devedesetih godina dvadesetog veka studije na srcima sa ugradjenim LVAD-om kao mostom do transplantacije srca dokazale su da dolazi do regresije ćelijske hipertofije , normalizacije veličine ćelija, arhitekture mišićnih vlakana i geometrije srčanih komora. Opisane promene okarakterisane su pojmom reverznog remodelinga što je sinonim za oporavak funkcije. Upravo se ovaj  proces na nivou desne komore prepoznaje kao izuzetno značajan za uspeh LVAD programa ,posebno u grupi bolesnika koji preoperativno imaju određeni stepen slabosti desne komore.

Osnovni zahtevi kardiohirurrškog tima su adekvatna preoperativna procena stepena slabosti desne komore , zatim primena mera koje preveniraju  oštećenje i opterećenje desne komore u toku i nakon LVAD implantacije  , kao i  obezbeđivanje adekvatnih terapijsko  mera za oporavak desne komore u postimplantacionom periodu.

Reference

Reference



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Objavljeno
2023/02/06
Broj časopisa
Vol. 73 Br. 4 (2022): Medicinski podmladak
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