Young J B
Kaufman Center for Heart Failure, Section of Heart Failure and Cardiac Transplant Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA.
Ann Thorac Surg. 2001 Mar;71(3 Suppl):S210-9. doi: 10.1016/s0003-4975(00)02633-3.
As experience has grown with the use of mechanical circulatory support systems in patients with cardiogenic shock, many anecdotes have been noted where myocardial recovery occurred and devices could be removed with reasonable residual cardiovascular performance and resolution of the shock syndrome. Indeed, when first used, ventricular assist devices were inserted to bridge patients unable to be separated from cardiopulmonary bypass to eventual recovery. Many successes with ventricular support systems have been recorded in individuals with postcardiotomy cardiogenic shock, acute myocarditis, and in the periinfarction period where stunning of potentially viable myocardial tissue contributed to severe heart failure. From an experimental standpoint, recovery of myocyte function and restoration of more normal myocardial geometry and constitution have been noted. There are many explanations for this, but principally, benefit is related to amelioration of circulatory insufficiency with attenuation of perturbed humoral networks and reduction of myocardial wall stress. It is important to understand how ventricular assist device implantation in select advanced heart failure patients might precipitate recovery of depressed myocardial function.
随着在心源休克患者中使用机械循环支持系统的经验不断积累，人们注意到了许多心肌恢复且装置得以移除的实例，患者在移除装置后仍具有合理的心血管功能残余且休克综合征得以缓解。实际上，心室辅助装置最初使用时是为了帮助那些无法脱离体外循环的患者过渡到最终康复。心室支持系统在心脏术后心源休克、急性心肌炎以及梗死周围期的患者中取得了诸多成功，在这些情况下，潜在存活心肌组织的顿抑导致了严重心力衰竭。从实验角度来看，已观察到心肌细胞功能的恢复以及更正常的心肌几何结构和组成的恢复。对此有多种解释，但主要而言，益处与循环功能不全的改善、紊乱体液网络的减轻以及心肌壁应力的降低有关。了解在特定晚期心力衰竭患者中植入心室辅助装置如何促使心肌功能恢复很重要。
