Zerkowski H R, Grapow M T, Todorov A, Morawietz H
Universitätsklinik für Herz- und Thoraxchirurgie, Kantonsspital Basel.
Z Kardiol. 2000;89 Suppl 7:76-84.
Mortality of chronic heart failure in industrial countries remains unacceptably high despite advances in medical therapy. Heart transplantation, the gold standard in the treatment of end-stage heart failure is reserved for only a few patients because of the shortage of donor hearts. Surgical alternatives to transplantation include dynamic cardiomyoplasty (CMP), mitral valve reconstruction, left ventricular reduction surgery (PLVR) and ventricular assist devices (VAD). Improved survival and objective physiologic improvement have not been documented for CMP in the treatment of dilative cardiomyopathy. Mitral valve reconstruction on the other hand shows promising results. PLVR is an innovative procedure in which the heart is surgically reduced in size and cardiac function is dramatically improved immediately after surgery. The presence of long-term effects is still unknown. VAD have been shown to be extremely effective as a short- and long-term "bridge" to heart transplantation. They are not approved for permanent support. A randomized trial in the U.S. is underway to compare the efficacy of these devices with the efficacy of medical therapy in NYHA functional class IV patients in quality of life, survival and costs.
尽管医学治疗取得了进展，但工业化国家慢性心力衰竭的死亡率仍然高得令人无法接受。心脏移植作为终末期心力衰竭治疗的金标准，由于供体心脏短缺，仅适用于少数患者。移植的手术替代方案包括动力性心肌成形术（CMP）、二尖瓣重建、左心室减容手术（PLVR）和心室辅助装置（VAD）。CMP治疗扩张型心肌病尚未证明能提高生存率和客观改善生理功能。另一方面，二尖瓣重建显示出有希望的结果。PLVR是一种创新手术，通过手术减小心脏大小，术后心脏功能立即得到显著改善。长期效果尚不清楚。VAD已被证明作为心脏移植的短期和长期“桥梁”非常有效。它们未被批准用于永久性支持。美国正在进行一项随机试验，比较这些装置与药物治疗对纽约心脏协会（NYHA）心功能IV级患者在生活质量、生存率和成本方面的疗效。
