Assessment of right ventricular morphological and functional parameters - data from the database of patients treated with left ventricular assist devices

Uređaj za mehaničku potporu srčanoj klijetci (VAD, prema eng. Ventricular Assist Device) je crpka koja pomaže radu srca i protoku krvi kroz tijelo, a koristi se u bolesnika sa uznapredovalim zatajivanjem srca. Uređaji za mehaničku potporu klijetci nose određene rizike i komplikacije. Zatajivanje desne klijetke (DK) je jedan od glavnih uzroka smrtnosti u bolesnika liječenih LVAD-om, a očituje se nemogućnošću desne klijetke da pruži odgovarajući volumen punjenja (eng. preload) lijevoj klijetci. Cilj ovog rada je bio procjena morfoloških i funkcijskih parametara DK te njihova povezanost s ishodom liječenja u svrhu poboljšanja kriterija za odabir kandidata za ugradnju LVAD-a. Ova retrospektivna studija provedena je u Klinici za bolesti srca i krvnih žila Medicinskog fakulteta Sveučilišta u Zagrebu i Kliničkog bolničkog centra Zagreb. U svrhu izrade ovog diplomskog rada, osnovana je baza podataka bolesnika kojima je ugrađen LVAD u razdoblju 2010.-2013. godine te je uključivala 20 bolesnika. Analiza ehokardiografskih parametara DK kao i mjerenja desnostranom kateterizacijom srca prije ugradnje LVAD-a nije izdvojila određeni parametar značajan u predilekciji ishoda, što se može tumačiti očuvanom građom i tek blaže narušenom funkcijom DK u naših bolesnika. Međutim, zabilježen je značajno niži preimplantacijski broj trombocita u bolesnika koji su umrli nakon ugradnje LVAD-a, kao i značajan postoperacijski porast plućne vaskularne rezistencije u tih bolesnika. Očekujemo da bi daljnja istraživanja mogla rasvijetliti mehanizam porasta plućne vaskularne rezistencije i povezanost s lošim postoperacijskim ishodom, dovesti do poboljšanja odabira kandidata za ugradnju LVAD-a, optimizaciji medikamentne terapije te posljedično boljeg ishoda liječenja.Ventricular Assist Device (VAD) is a pump that supports the heart function and circulation in patients with advanced heart failure. Ventricular Assist Devices involve certain risks and complications. Failure of the right ventricle (RV) is a major cause of mortality in patients treated with an LVAD, reflecting the inability of the RV to provide adequate preload to the left ventricle. The aim of this study was to assess the morphological and functional parameters of the RV and their association with the outcome of treatment in order to improve the criteria for selection of candidates for the implatation of an LVAD. This retrospective study was conducted at the Clinic for Cardiovascular Diseases, University of Zagreb School of Medicine, Zagreb University Hospital Center. For the purpose of this thesis, a database of patients with an implanted LVAD in the period from 2010 to 2013 has been established and included 20 patients. The analysis of echocardiographic parameters of the RV and the right heart catheterization measurements conducted before the LVAD implantation has not identified a specific parameter as a significant predilector of outcomes, which can be interpreted due to an intact structure and only milder functional impairment of the RV in our patients. However, there was a significantly lower pre-implantation platelet count in patients who have died after the LVAD implantation, as well as a significant increase in postoperative pulmonary vascular resistance in these patients. We expect that further research could shed light on the mechanism of the increase in pulmonary vascular resistance and its correlation with poor postoperative outcome, leading to improvements in the selection of candidates for the implantation of LVADs, the optimization of drug therapy and consequently better treatment outcomes