Lokalne komplikacije kod bolesnika s implantiranom mehaničkom cirkulacijskom potporom

master's thesis

• Title (english): Local complications in patients with implanted mechanical circulatory support
• Author: Ivana Jelinek
• Mentor: Željko Sutlić (mentor)
• Committee member: Mario Starešinić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Željko Sutlić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2018-03-06, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Mehanička cirkulacijska potpora najinovativniji je način liječenja bolesnika s uznapredovalim zatajenjem srca. Ovakav oblik terapije koristi se kao most do oporavka, transplantacije ili kao oblik destinacijske terapije u bolesnika koji nisu kandidati za transplantaciju srca. 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 kod bolesnika čije srce više nije sposobno adekvatno obavljati svoju funkciju. Takvi uređaji puno se češće koriste za potporu lijevoj klijetci (LVAD, prema eng. Left Ventricular Assist Device), a postoje i rjeđe korišteni RVAD uređaji (prema eng. Right Ventricular Assist Device). LVAD terapija je terapija prvog izbora kod bolesnika s uznapredovalim zatajenjem srca i povezana je s ozbiljnim popratnim događajima poput moždanog udara, krvarenja,
zatajenja desnog srca, kvarom uređaja te infekcijama. Infekcije mjesta izlaska perkutanog kabela su najčešće i najvažnije komplikacije kod bolesnika s implantiranom mehaničkom cirkulacijskom potporom. Današnji LVAD-ovi još uvijek zahtijevaju perkutani kabel, koji je poveznica pumpe i regulatora te isporučuje energiju iz vanjskog izvora, a predstavlja ulazno mjesto za mikroorganizme. Infekcije povezane s LVAD-om imaju značajan utjecaj na klinički ishod bolesnika. Prema istraživanjima, bolesnici koji su imali infekciju imaju značajno nižu stopu preživljenja u usporedbi s bolesnicima bez infekcije. Također, bolesnici koji su u ranom postoperativnom tijeku nakon implantacije pumpe imali infekciju, imaju visok rizik za reoperaciju zbog krvarenja, zatajenja bubrega koje je često praćeno multiorganskim zatajenjem. Osim navedenih lokalnih komplikacija, nepovoljan utjecaj na klinički ishod imaju komplikacije u obliku tromboze pumpe. S obzirom da se komplikacije ne pojavljuju samo u
ranom postoperativnom tijeku dok je bolesnik hospitaliziran, nego je izložen njima i nakon otpusta iz bolnice, od najvećeg značenja ostaje rano prepoznavanje i liječenje komplikacija kako bi se bolesnicima omogućila što bolja kvaliteta života.

Abstract (english)

Mechanical circulatory support is the most innovative way of treating patients with advanced heart failure. This type of therapy is used as a bridge to recovery, transplantation or as a form of destination therapy in patients who are not candidates for heart transplantation. The Ventricular Assist Device (VAD) is a pump that helps the heart's work and pump blood through the body, and it is used in patients whose hearts are no longer able to adequately perform their function. This devices are much more commonly used for left ventricular assist devices (LVAD), and there are less commonly used RVAD devices (Right Ventricular Assist Device). LVAD therapy is the first choice of therapy in patients with advanced heart failure but it is associated with serious side events such as stroke, bleeding, heart failure, device failure, and infections. Driveline infections are the most common and most important complications in patients with implanted mechanical circulatory support. Today's LVADs still require a percutaneous cable, a pump and regulator link, and supplies energy from an external source, and it is an input for microorganisms. Infections associated with LVAD have a significant effect on the clinical outcome of the patient. According to research, patients who had an infection had a significantly lower survival rate compared to patients without infection. Also, patients who had an early post-operative operation after implantation of the pump had an infection, have high risk for re-operation due to bleeding, kidney failure often accompanied by multi-organ failure. Ecxcept local complications, adverse effects on clinical outcome have complications in the form of thrombosis of the pump. Since complications not occur only in the early postoperative course while the patient is hospitalized than exposed to them after hospital discharge, the most important is the early detection and treatment of complications in order to provide the patients as good as possible quality of their life.

• Keywords: zajivanje srca; mehanička cirkulacijska potpora; infekcije povezane s LVAD-om
• Keywords (english): heart failure; mechanical circulation relief; LVAD-associated infections
• Language: croatian
• URN:NBN: urn:nbn:hr:105:038732
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-22 08:41:37