Vitali E, Lanfranconi M, Bruschi G, Ribera E, Garatti A, Colombo T, Russo C F
Department of Cardiac Surgery "Angelo De Gasperis," Niguarda Cà Granda Hospital, Milan, Italy.
Transplant Proc. 2004 Apr;36(3):620-2. doi: 10.1016/j.transproceed.2004.02.050.
Ventricular assist devices (VADs) have become important therapeutic tools to treat patients with end-stage cardiac failure. VADs are an essential component of transplantation programs as they successfully bridge individuals who would otherwise die. Recently left ventricular VAD (LVAD) therapy has been proposed as alternative to heart transplantation (HTx) for patients who are not transplant candidates. Other indications have now expanded into areas such as postcardiotomy failure, acute myocarditis, and acute massive myocardial infarction. From 1988 to May 2003, 80 patients received left or biventricular mechanical circulatory support including 78 as a bridge to and two as an alternative to HT. All patients survived the operation. Mean duration of VAD support was 77 +/- 150 days. Fifty-one points (63.8%) underwent heart transplantation; 3 (3.8%) recovered and were weaned from VADs. Major bleeding episodes occurred in 11 patients (13.8%) and major neurologic events occurred in 8 (10%). Sixteen patients (20%) were discharged home while waiting for HTx. Twenty-two patients (27.5%) died on VAD. In conclusion, VAD therapy proved effective in bridging patients with end-stage heart failure to HTx. While on LVAD support patients who were assisted with implantable wearable devices could be discharged at home, improving their quality of life.
心室辅助装置（VADs）已成为治疗终末期心力衰竭患者的重要治疗工具。VADs是移植项目的重要组成部分，因为它们成功地挽救了那些否则会死亡的患者。最近，对于不适合心脏移植的患者，左心室辅助装置（LVAD）治疗已被提议作为心脏移植（HTx）的替代方案。现在，其他适应症已扩展到诸如心脏切开术后衰竭、急性心肌炎和急性大面积心肌梗死等领域。从1988年到2003年5月，80例患者接受了左心室或双心室机械循环支持，其中78例作为心脏移植的过渡，2例作为心脏移植的替代方案。所有患者均存活至手术结束。VAD支持的平均持续时间为77±150天。51例患者（63.8%）接受了心脏移植；3例（3.8%）康复并脱离了VADs。11例患者（13.8%）发生了严重出血事件，8例（10%）发生了严重神经系统事件。16例患者（20%）在等待心脏移植期间出院回家。22例患者（27.5%）在使用VAD时死亡。总之，VAD治疗被证明在将终末期心力衰竭患者过渡到心脏移植方面是有效的。在LVAD支持下，使用可植入式可穿戴设备辅助的患者可以出院回家，从而提高他们的生活质量。
