Benetis R
Clinic of Cardiac Surgery, Kaunas Heart Center, Kaunas Medical University, Lithuania.
Rocz Akad Med Bialymst. 2005;50:45-9.
Heart failure (HF) is a pathophysiological condition, when the heart can not provide adequate blood flow to the body organs. The main cause of HF is now ischemic heart disease (IHD), and the number of patients with HF in aging society is growing. HF is becoming the leading cause of death. Medical therapy does not provide satisfactory results in respect of symptoms and survival (5 year survival 28-40%). Therefore there is a trend towards early invasive methods of IHD treatment: percutaneous or surgical revascularisation and surgical reconstruction of myocardial damage. Most common surgical procedure in IHD is coronary artery bypass grafting (CABG). This treatment is safe and effective in patients with normal ventricular function (operative mortality 0.5%, 5 year survival >92%). Results in patients with impaired left ventricular (LV) function are better than conservative therapy, but still not satisfactory (operative mortality 8.4%, 5 year survival 65%). The modern surgical concept for improvement of ventricular function is left ventricular (LV) shape and volume restoration (SVR) accompanied by CABG. In cases of severe damage of myocardium resulting in left ventricular aneurysm or akinesia, SVR improves LV function and prevents further LV remodeling. At present it is under investigation whether SVR is of benefit for moderate-sized ventricles and NYHA class II symptoms. In case of ischemic mitral insufficiency mitral valve repair is a method of choice. The results of combined procedures in Heart Failure group (CABG + MV reconstruction or SVR) are better than CABG alone. Other surgical alternatives for HF treatment are: heart transplantation, ventricular assist devices (VAD), dynamic cardiomyoplasty, constrictive devices and cellular transplantation therapy. Heart transplantation is reserved for younger patients with less comorbidities. Shortage of donor organs and poor long-term results remains a main problem of such a treatment. VAD at present is still very expensive, and serves particularly as a "bridge to heart transplantation" or "bridge to recovery" rather than destination therapy. Despite of all achievements in medical or invasive HF treatment further basic and clinical works as well as new organization systems are necessary to find optimal strategies to reduce cost of care, improve quality of life and survival.
心力衰竭（HF）是一种病理生理状态，此时心脏无法为身体器官提供足够的血流。HF的主要病因目前是缺血性心脏病（IHD），并且在老龄化社会中HF患者的数量正在增加。HF正成为主要的死亡原因。就症状和生存率而言，药物治疗并未取得令人满意的结果（5年生存率为28 - 40%）。因此，存在一种采用IHD早期侵入性治疗方法的趋势：经皮或手术血运重建以及心肌损伤的手术重建。IHD中最常见的外科手术是冠状动脉旁路移植术（CABG）。这种治疗对于心室功能正常的患者是安全有效的（手术死亡率为0.5%，5年生存率>92%）。左心室（LV）功能受损患者的治疗结果优于保守治疗，但仍不尽人意（手术死亡率为8.4%，5年生存率为65%）。改善心室功能的现代外科理念是在进行CABG的同时进行左心室（LV）形状和容积恢复（SVR）。在心肌严重受损导致左心室动脉瘤或运动不能的情况下，SVR可改善LV功能并防止LV进一步重塑。目前正在研究SVR对于中等大小心室和纽约心脏协会（NYHA）II级症状是否有益。对于缺血性二尖瓣关闭不全，二尖瓣修复是首选方法。心力衰竭组联合手术（CABG + MV重建或SVR）的结果优于单纯CABG。HF治疗的其他外科替代方法包括：心脏移植、心室辅助装置（VAD）、动力性心肌成形术、缩窄装置和细胞移植治疗。心脏移植适用于合并症较少的年轻患者。供体器官短缺和长期效果不佳仍然是这种治疗的主要问题。目前VAD仍然非常昂贵，并且主要用作“心脏移植的桥梁”或“恢复的桥梁”，而非最终治疗手段。尽管在HF的药物或侵入性治疗方面取得了所有成就，但仍需要进一步的基础和临床研究以及新的组织系统，以找到降低护理成本、改善生活质量和生存率的最佳策略。
