MECHANICAL CIRCULATORY SUPPORT IN ADVANCED HEART FAILURE

Abstract

The human heart is composed of 2 sides, the right and the left. Each side consists of an atrium and a ventricle with a valve in between, the mitral on left side and the tricuspid on right side. There is a bicuspid valve at the outflow tract of each ventricle the aortic and the pulmonary. The heart is supplied through the coronary arteries and drains blood through the coronary veins. His–Purkinje system is responsible for electrical conduction between cardiac chambers. Heart failure is a worldwide problem with a high incidence with many risk factors that may affect its incidence. Heart failure is classified according the ACCF-AHA or NYHA classifications. There are many compensatory mechanisms occurred in heart failure as: Frank–Starling mechanism, ventricular remodelling and activation of neurohormonal systems. Manifestations of heart failure are in the form of pulmonary congestion, systemic congestion and symptoms of low cardiac output. Medical management includes diuresis, suppression of the overactive neurohormonal systems, and augmentation of contractility. Surgical options include ventricular resynchronization therapy, intracardiacdefibrilator, ventricular assist devices and heart transplantation. Despite heart transplantation being the gold standard in advanced heart failure, mechanical circulatory support devices were used to overcome the problem of cardiac donors’ shortage. They have 3 main indications: bridge to decision, bridge to heart transplantation or as a destination therapy. They may be implanted subcutaneously or surgically. Infection, thromposis, pump failure are common side effects.