Christian Andres Bermudez

Patients requiring a right ventricular assist device (RVAD) after durable left ventricular assist device (LVAD) surgery have historically worse outcomes than those with isolated LVADs. Preoperative mechanical circulatory support (MCS) with venoarterial extracorporeal membrane oxygenation (ECMO) or micro-axial pumps complicates right heart assessment by altering loading conditions. We examined 1 year outcomes of patients receiving temporary RVADs at the time of durable LVAD. From February 2017 to August 2025, 102 patients were reviewed. Right ventricular assist device decannulation, ventilator liberation, and intensive care unit (ICU) discharge were assessed using Fine–Gray subdistribution analysis with death as a competing risk; 1 year survival was evaluated by Kaplan–Meier analysis. Analysis included 59 planned, 28 unplanned, and 15 delayed RVADs (45 percutaneous, 57 surgical). One year survival was 64.0 ± 6.5% for planned, 50.2 ± 10.3% for unplanned, and 50.3 ± 13.6% for delayed RVAD. Percutaneous and surgical RVAD survival were 60.1 ± 7.5% and 55.1 ± 7.1%. Preoperative MCS was independently associated with improved survival (hazard ratio [HR]: 0.36, confidence interval [CI]: 0.17–0.83), with micro-axial pump showing the strongest association. Preoperative micro-axial support and planned RVAD were associated with improved 1 year survival after durable LVAD surgery; whether this reflects a causal relationship where the preconditioning of the right ventricle improves postoperative outcomes cannot be determined from this retrospective design.

A 44-year-old male with pulmonary sarcoidosis related interstitial lung disease and pulmonary hypertension was admitted for pre-transplant evaluation. During hospitalization, he developed cardiac arrest due to worsening respiratory failure and was immediately placed on veno-arterial (VA) extracorporeal membrane oxygenation (ECMO). Despite initial improvement, he developed differential oxygenation, which was managed by converting the support to veno-venoarterial (VVA) ECMO. However, pulmonary artery pressure increased, placing a greater load on the right ventricle, and oxygenation remained inadequate, leading to further optimization of the ECMO settings. The support was switched to veno-pulmoarterial (VPA) ECMO, which improved oxygenation and, through the combined effects of oxygenation and circulatory support, stabilized his condition. After 24 days of ECMO support, the patient underwent successful lung transplantation. His postoperative course was uncomplicated, and he was discharged on postoperative day 32. Over the subsequent 2 years of follow-up, he has remained active, independent of oxygen, and free of functional limitations.

La inteligencia artificial transforma procesos sociales y jurídicos, pero plantea riesgos éti-cos y legales. Su uso responsable exige garantizar transparencia, equidad y protección de derechos fundamentales, evitando discriminación algorítmica y asegurando que la tecnología respete la dignidad humana. Al respecto el objetivo del presente estudio fue analizar críticamente la evidencia académica sobre sus impactos y desafíos normativos. Esta investigación se caracterizó como un estudio de tipo básico, con un diseño no expe-rimental de corte transversal, enfocado en el análisis documental. Para lo cual se realizó una revisión sistemática PRISMA de 30 estudios (2018-2025). Los resultados cuantitati-vos identificaron como principales riesgos la opacidad algorítmica (35.5%), los vacíos re-gulatorios (32.3%) y las amenazas a la privacidad (29%). Se concluye que es imperativo desarrollar un marco regulatorio integral basado en transparencia, supervisión indepen-diente y participación ciudadana para armonizar el desarrollo tecnológico con la protec-ción efectiva de los derechos fundamentales.

An abstract is unavailable. This article is available as a PDF only.