Houston Methodist Heart and Vascular Center, Methodist J.C. Walter Transplant Center, Houston, Texas.
Mechanical Circulatory Support Program, Cardiac Critical Care, Henry Ford Advanced Heart Failure Program, Detroit, Michigan.
J Card Fail. 2023 Apr;29(4):479-502. doi: 10.1016/j.cardfail.2023.01.009. Epub 2023 Feb 22.
The medical management of patients supported with durable continuous flow left ventricular assist device (LVAD) support encompasses pharmacological therapies administered in the preoperative, intraoperative, postoperative, and chronic LVAD support stages. As patients live longer on LVAD support, the risks of LVAD-related complications and progression of cardiovascular and other diseases increase. Using existing data from cohort studies, registries, randomized trials, and expert opinion, this Heart Failure Society of America Consensus Document on the Medical Management of Patients on Durable Mechanical Circulatory Support offers best practices on the management of patients on durable mechanical circulatory support, focusing on pharmacological therapies administered to patients on continuous flow LVADs. Although quality data in the LVAD population are few, the use of guideline-directed heart failure medical therapies and the importance of blood pressure management, right ventricular preload and afterload optimization, and antiplatelet and anticoagulation regimens are discussed. Recommended pharmacological regimens used to mitigate or treat common complications encountered during LVAD support, including arrhythmias, vasoplegia, mucocutaneous bleeding, and infectious complications, are addressed. Finally, this document touches on important potential pharmacological interactions from antidepressants and herbal and nutritional supplements of relevance to providers of patients on LVAD support.
使用左心室辅助装置（LVAD）持续循环支持的患者的医学管理包括在术前、术中和术后以及慢性 LVAD 支持阶段给予的药物治疗。随着患者在 LVAD 支持下的存活时间延长，LVAD 相关并发症的风险以及心血管和其他疾病的进展风险增加。本美国心力衰竭学会关于使用耐用性机械循环支持的患者的医学管理的共识文件利用来自队列研究、注册中心、随机试验和专家意见的现有数据，提供了有关使用耐用性机械循环支持的患者的管理的最佳实践，重点是对接受连续流 LVAD 的患者给予药物治疗。尽管 LVAD 人群中的高质量数据很少，但讨论了指南指导的心力衰竭药物治疗的使用以及血压管理、右心室前负荷和后负荷优化以及抗血小板和抗凝方案的重要性。本文还讨论了用于减轻或治疗在 LVAD 支持期间遇到的常见并发症（包括心律失常、血管麻痹、黏膜皮肤出血和感染性并发症）的推荐药物治疗方案。最后，本文还涉及与接受 LVAD 支持的患者的提供者相关的抗抑郁药和草药及营养补充剂的重要潜在药物相互作用。
