Seshiah Puvi, Chung Eugene, Garcia Santiago, Choo Joseph, Dowling Robert, Answini Geoffrey, Kereiakes Dean, Egnaczyk Gregory
The Christ Hospital Heath Network, The Heart & Vascular Institute, Cincinnati, OH 45219, USA.
Department of Cardiology, Charleston Area Medical Center/Vandalia Health, Charleston, WV 25304, USA.
Rev Cardiovasc Med. 2025 Apr 24;26(4):27964. doi: 10.31083/RCM27964. eCollection 2025 Apr.
Left ventricular assist devices (LVADs) have changed the landscape for patients with advanced heart failure (HF). With advances in pump design and management, patients with LVADs are living longer with improved quality of life despite having more comorbidities and complex structural heart disease. As such, HF cardiologists and surgeons collaborate more frequently with structural heart interventionalists to address the complex problems of patients with LVADs who present at different points of failure in their circuits. Unlike heart transplants and total artificial heart recipients, the native heart and its components must function to maintain successful circulatory support from these assist devices. Multiple points of potential failure of the native heart and the LVAD circuit exist that can result in significant morbidity and mortality. These include regurgitant valve lesions, interatrial shunts, outflow cannula obstruction, and pump thrombosis. Transcatheter interventions can be applied and tailored specifically to the anatomy of the individual in these situations to improve the lives and outcomes of our LVAD patients. This review provides a comprehensive approach for diagnosing and treating structural heart disease associated with patients who have LVADs, focusing on multidisciplinary collaboration and individualized interventional strategies.
左心室辅助装置（LVADs）改变了晚期心力衰竭（HF）患者的治疗局面。随着泵设计和管理方面的进步，尽管患有更多合并症和复杂的结构性心脏病，但LVAD患者的寿命更长，生活质量也有所提高。因此，HF心脏病专家和外科医生与结构性心脏病介入专家的合作更加频繁，以解决LVAD患者在其循环系统不同衰竭点出现的复杂问题。与心脏移植和全人工心脏接受者不同，天然心脏及其组成部分必须发挥功能，以维持这些辅助装置成功的循环支持。天然心脏和LVAD循环系统存在多个潜在的故障点，可能导致严重的发病率和死亡率。这些包括反流性瓣膜病变、心房分流、流出道插管阻塞和泵血栓形成。在这些情况下，可以应用经导管干预并根据个体解剖结构进行专门调整，以改善LVAD患者的生活和预后。本综述提供了一种全面的方法，用于诊断和治疗与LVAD患者相关的结构性心脏病，重点是多学科合作和个体化介入策略。
