Clinical Features of Short- and Long-term Mechanical Circulatory Support
Klinische aspecten van korte en lange termijn mechanische circulatie ondersteuning
Short- and long-term mechanical circulatory support devices are increasingly used in acute and chronic heart failure. Due to the donor shortage, the indications for LVAD therapy have been expanded from bridge-to-transplantation to destination therapy. Furthermore, an ICU admission of patients supported by ECMO after cardiogenic shock can result in the need of LVAD therapy. ECMO therapy is becoming a cornerstone in the treatment of acute cardiogenic shock, as it can serve as bridge to recovery and also as a bridge transplantation or LVAD. During the follow-up of these patients in the ICU and at the outpatient clinic it is very important to prevent and diagnose complications timely, thus avoiding devastating outcomes.
As a consequence of the altered circulatory status in patients with LVAD and ECMO, conventional measures such as clinical, biochemical, echocardiograph ic and laboratory follow-up is not always sufficient and time consuming. Despite advances in hemodynamic monitoring techniques complications and weaning attempts from ECMO are still lacking in monitoring the end-organ function. Therefore, novel imaging techniques for microcirculatory monitoring in patients with mechanical circulatory support has been analysed in this thesis. We predict that in the near future more advanced monitoring techniques will be available for monitoring the artificial circulations for short-and long-term support.