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Effect of continuous blood flow on cerebrovascular perfusion and hemocoagulation in patients with implantable left ventricular assist device
Koňařík, Miroslav ; Szárszoi, Ondrej (advisor) ; Ošťádal, Petr (referee) ; Brát, Radim (referee)
Implantation of left ventricular assist devices (LVADs) is an integral treatment modality in patients with heart failure. In most cases, it refers to a machine which generates continuous blood flow with reduced pulse pressures. The effect of reduced pulsatility on organ function, such as homeostatic regulatory mechanisms is still unknown. The goal of our study was to understand whether continuous blood flow generated by mechanical support devices affects cerebrovascular regulatory mechanisms (study A), and whether or not hemocoagulation is affected in regard to complications relating to hemocompatibility (study B). Study A utilized finger plethysmography and TCD ultrasonography to detect possible changes in static cerebral auto-regulation when compared to a range of rotations per minute (rpm) of the LVAD, which served as a model for either accentuation or reduction in residual arterial pulsatility. Study B divided patients with implanted LVADs based on the incidence of selected thrombophilic mutations. Both groups of patients were placed on individualized anticoagulation protocols. The results were focused on the incidence of thromboembolic and hemorrhagic complications, and eventual morbidity/mortality of the patient. Our findings did not confirm disruption to static cerebral auto-regulation,...
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Life after a heart transplant
Kováčová, Anna ; Kordulová, Pavla (advisor) ; Dynáková, Šárka (referee)
Patients with terminal heart failure that cannot be treated with conventional therapies are indicated for heart transplantation. In acute deterioration, patients can be brought to transplant using a mechanical cardiac support that is able to partially or completely take over the role of the heart and allow the restoration of sufficient cardiac output (Fila et al., 2014). The period before and after transplantation represents a very challenging period for patients, when they feel not only physical, but especially mental and social needs, which change during their phases of life and at the same time affect their entire subsequent experience. The main goal of this diploma thesis was to monitor how the previous implantation of long-term mechanical cardiac support and the subsequent heart transplantation affect the needs and feelings of patients. Respondents were selected from patients who had been implanted with mechanical cardiac support prior to heart transplantation. The diploma thesis contained another five sub- objectives, which dealt with mapping the needs of patients before and after implantation of long- term mechanical cardiac support and after heart transplantation, as well as during compliance with regimen measures, information retrieval and education. For qualitative research, the method of...
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