Effective treatment of severe heart failure with ‘left ventricular assist device’

[이데일리 이순용 기자] Heart failure is a disease where the heart cannot supply enough blood to the whole body, and when heart failure develops, it is a frightening disease that leads to death due to a reduction in the heart’s function. Recently, in Korea, left ventricular assist device (LVAD) treatment, which helps supply blood to the whole body by inserting a pump that helps the function of the heart’s left ventricle, has become possible. A case of successful treatment has been published the patient for the first time. online in the European Heart Journal, an authoritative international journal.

The Catholic University of Korea Seoul St. Hospital Mair Cardiocerebrovascular Hospital Department of Cardiology Jong-chan Yun (corresponding author) So-young Lee (first author) and Department of Radiology Professor Soo-yeon Jang (co-author) recently diagnosed thrombosis in the proximal aorta (just above the valve aortic) in a patient who had recently undergone LVAD surgery It was effectively treated by a multidisciplinary approach. A patient in his 70s underwent LVAD surgery as a radical alternative to hospitalization and heart transplantation more than three times a year due to worsening symptoms of heart failure due to ischemic cardiomyopathy after myocardial infarction.

On the 11th postoperative day, a large thrombus was found just above the aortic valve, so through multidisciplinary collaboration with cardiology, thoracic surgery, and radiology, LVAD pump speed control and anticoagulant treatment were prioritized over reoperation to remove the thrombus. w As a result of adjusting the LVAD pump speed to prevent systemic embolism or myocardial infarction due to blood clots, the blood clots disappeared after 3 weeks, and the patient was discharged without any special side effects or complications, and daily life was possible without symptoms of heart failure.

[A, C] A large thrombus is seen on a CT scan just above the aortic valve. [ B, D] Clots disappeared on follow-up CT after LVAD device adjustment and anticoagulant treatment.

Heart failure is a condition in which the heart cannot supply enough blood to the whole body due to functional or structural abnormalities, the main symptoms of which are dyspnea, edema and fatigue. It can be caused by various heart diseases such as ischemic cardiomyopathy such as myocardial infarction, definite cardiomyopathy, high blood pressure, and valvular heart disease.

Currently, the number of heart failure patients in Korea is about 750,000, and the incidence rate is increasing rapidly due to the increase in cardiovascular disease risk factors due to the westernization of eating habits and lack of physical activity and the population that’ n getting old. Heart failure is one of the leading causes of hospitalization and death in the elderly population aged 65 and over, and the incidence rate in those aged 80 and over is about 15 times the total incidence, and the incidence rate increases rapidly with age. . Heart failure with reduced left ventricular ejection, an indicator of the heart’s contractile function, is known to cause death in 1 in 4 people within a year of diagnosis and 1 in 2 deaths within 5 years.

The goal of heart failure treatment is to relieve symptoms and live longer, and recently various drugs and procedures have been developed that can improve prognosis. Heart failure where symptoms persist despite the best possible treatment is called severe heart failure

If symptoms in patients with severe heart failure are not controlled despite pharmacotherapy and optimized surgical treatment for heart failure, a left ventricular assist device (LVAD) or heart transplant is considered. LVAD treatment refers to a surgical treatment method that helps supply blood to the whole body through the aorta by inserting a pump that helps the function of the left ventricle of the heart like the principle of a water pump for patients with severe heart failure with reduced size. left ventricular function.

If the waiting period for a heart transplant is long, LVAD surgery is performed first and then a heart transplant is performed later (Bridge to Transplant, heart transplant bridging treatment) after performing daily life , Destination Therapy (last treatment) may be the goal.

Seoul St Mary’s Hospital performs surgery with Abbott’s ‘HeartMate3’, the latest LVAD. This is a model that uses a centrifugal pump using the principle of magnetic levitation to significantly reduce the stroke and the formation of blood clots in the pump, which are the current major complications of left ventricular assist devices, and it is a safe type currently used for most patients with severe. heart failure

Professor Yoon Jong-chan said, “Heart transplantation is also an effective treatment that can improve the survival rate and quality of life of patients with severe heart failure, but the number of heart transplants is currently limited due to the lack of brain dead donors. The 2-year survival rate was 84.5%, and the 2-year survival rate without major complications such as major stroke or pump replacement was 76.9%, which was similar to that of high-risk heart transplant patients, making left ventricular assist device treatment a more important.” he did


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