Christiansen Stefan, Brose Stefan, Autschbach Rüdiger
Klinik für Thorax-, Herz- und Gefässchirurgie, Universitätsklinikum, Rheinisch-Westfälische Technische Hochschule, Aachen.
Herz. 2003 Aug;28(5):380-92. doi: 10.1007/s00059-003-2397-8.
Heart failure is still associated with a poor prognosis despite great advances in drug therapy, so that surgical procedures are necessary in patients with end-stage cardiac failure. Cardiac transplantation was the therapy of choice during the last decades, but due to its disadvantages and the increasing scarcity of donor organs other surgical procedures were developed. Multisite pacing improves quality of life, but a longterm survival benefit remains to be proved. Coronary artery bypass grafting and valve surgery demonstrated to improve quality of life and to increase long-term survival. Ventricular assist devices are effective in bridging up to 70% of patients to cardiac transplantation, but the number of complications must be reduced. Partial left ventriculectomy may be performed with results similar to those obtained of cardiac transplantation, but long-term results are not yet available. Dynamic cardiomyoplasty and Myosplint implantation were not successful, but it must be awaited, if passive cardiomyoplasty leads to better results. Xenotransplantation is under intense investigation, but cannot be used clinically until now due to the hurdles of rejection and transfer of infectious diseases. This work provides a summary of today's knowledge about surgical procedures for end-stage heart failure.
尽管药物治疗取得了巨大进展，但心力衰竭的预后仍然很差，因此终末期心力衰竭患者需要进行外科手术。在过去几十年里，心脏移植是首选治疗方法，但由于其缺点以及供体器官日益稀缺，人们开发了其他外科手术。多部位起搏可改善生活质量，但长期生存获益仍有待证实。冠状动脉搭桥术和瓣膜手术已证明可改善生活质量并提高长期生存率。心室辅助装置在将多达70%的患者过渡到心脏移植方面是有效的，但必须减少并发症的数量。部分左心室切除术的效果可能与心脏移植相似，但长期结果尚不可得。动态心肌成形术和肌夹板植入术未获成功，但被动心肌成形术是否会带来更好的结果仍有待观察。异种移植正在进行深入研究，但由于排斥反应和传染病传播等障碍，目前尚不能用于临床。本文总结了目前关于终末期心力衰竭外科手术的知识。
