A pesar de los avances en todos los campos de la cardiología, la incidencia de insuficiencia cardiaca aumenta cada año. El tratamiento farmacológico, los dispositivos de resincronización y la cirugía de la insuficiencia cardiaca han conseguido prolongar la supervivencia de estos pacientes y mejorar sus síntomas. Sin embargo, en las fases más avanzadas de la enfermedad, estas opciones terapéuticas llegan a ser ineficaces, y son el trasplante cardiaco (TXC) y los dispositivos de asistencia circulatoria (DAC) los que pueden permitir prolongar la supervivencia y mejorar la calidad de vida.
El TXC es, desde hace 25 años, la opción terapéutica más efectiva para pacientes con insuficiencia cardiaca en fases terminales. La escasez de donantes apropiados y el desarrollo de otras alternativas terapéuticas eficaces en estadios menos avanzados hacen que este tratamiento se reserve para pacientes jóvenes que presentan cardiopatías con poca expectativa de vida a corto plazo.
Los DAC han demostrado su efectividad como terapia temporal, ya sea como puente al trasplante o como Puente a la recuperación, y también como soporte permanente en pacientes con contraindicaciones para TXC. Actualmente disponemos de asistencias paracorpóreas, intracorpóreas e incluso sistemas que permiten la completa sustitución del corazón. La generalización de su uso dependerá del establecimiento de unas indicaciones apropiadas, de la mejora en su relación coste-beneficio, y de la disminución de la aún importante tasa de complicaciones asociadas.
Palabras clave
Insuficiencia cardiaca avanzada
Trasplante cardiaco
Asistencia circulatoria
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