Role of Ventricular Assist Devices in Acute Heart Failure

Abstract

Background: Acute heart failure (AHF) is a clinical syndrome of new or worsening signs and symptoms of heart failure (decompensated), often leading to hospitalization or a visit to the emergency department. Patients with AHF represent a heterogeneous population with high post-discharge readmission rates. Most hospitalized patients have significant volume overload, and congestive symptoms predominate. Fewer patients present with hypotension and symptoms of reduced organ perfusion. A few patients who come to the emergency department with AHF have “flash pulmonary edema. AHF represents a period of high risk for patients, with a 20% to 30% mortality rate within 6 months after admission Early care of AHF and time to treatment are linked to outcome. Aim: Our aim in this essay is to summarize the current knowledge regarding acute heart failure and discuss the role of ventricular assist devices in its management, stressing important takeaway points for critical care physicians. Cardiogenic shock (CS) is defined as a state of critical end-organ hypoperfusion due to reduced cardiac output. Viable Dysfunctional (VD) myocardium: Multiple studies in humans and animals have shown that the functionality of myocardial tissue of a failing heart can be restored. Congestion affects lung function and increases intrapulmonary shunting, resulting in hypoxaemia. CPAP is a feasible technique in the pre-hospital setting, on hospital arrival, patients who still show signs of respiratory distress should continue with non-invasive ventilation, preferably PS-PEEP. In conclusion Acute heart failure and cardiogenic shock, regardless the cause, still have a dreadful outcome. Current management includes use of inotropic support and/or IABP. In the past decade, pVAD and ECLS have completed this armamentarium with which one can tackle these conditions. Keywords: Acute heart failure, Cardiogenic shock, Viable Dysfunctional, CPAP.