Kirklin James K, Holman William L
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Curr Opin Cardiol. 2006 Mar;21(2):120-6. doi: 10.1097/01.hco.0000210308.64360.8d.
Large pulsatile left ventricular assist devices have been used as bridge-to-transplant therapy for the past 20 years. Over the past 2 years, a number of smaller rotary pumps have been introduced into clinical trials in the United States, Europe, and Australia. These devices offer the potential for smaller operations, greater resistance to infection, and new opportunities for bridge-to-recovery therapy.
Ongoing trials with axial flow devices support greater durability and less device-related infection than the HeartMate XVE (Thoratec Corporation, Pleasanton, California, USA). A greater tendency for pump thrombus and a higher anticoagulation requirement, however, are disadvantages compared with the HeartMate device.
Large pulsatile left ventricular assist devices have been the mainstay of mechanical support. The combination of durability and smaller pump size has become a focus of mechanical circulatory support in the current era. Ongoing clinical trials in the United States with three rotary pumps in both bridge-to-transplant and destination trials will likely result in a major increase in options for circulatory support. At least five other small, durable devices have recently entered non-US trials and are poised for clinical studies in the US. The National Institutes of Health-sponsored Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) will facilitate the introduction of new technology and study patient and device outcomes.
在过去20年里，大型搏动性左心室辅助装置一直被用作移植过渡治疗。在过去两年中，一些较小的旋转泵已在美国、欧洲和澳大利亚进入临床试验。这些装置具有进行更小手术、更强抗感染能力的潜力，还为康复过渡治疗带来了新机遇。
与HeartMate XVE（美国加利福尼亚州普莱森顿的Thoratec公司）相比，正在进行的轴流装置试验显示出更高的耐用性和更低的装置相关感染率。然而，与HeartMate装置相比，泵血栓形成倾向更大且抗凝需求更高是其劣势。
大型搏动性左心室辅助装置一直是机械支持的主要手段。耐用性和更小泵尺寸的结合已成为当前时代机械循环支持的重点。美国正在进行的三项旋转泵用于移植过渡和目标治疗的临床试验可能会大幅增加循环支持的选择。最近至少还有其他五种小型耐用装置已进入美国以外地区的试验，并准备在美国开展临床研究。美国国立卫生研究院资助的机械辅助循环支持跨机构注册中心（INTERMACS）将促进新技术的引入，并研究患者和装置的结局。
