Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
J Cardiothorac Vasc Anesth. 2009 Oct;23(5):738-48. doi: 10.1053/j.jvca.2009.06.009. Epub 2009 Aug 15.
There has been significant progress in heart failure treatment; its stages are defined as a management platform for cardiovascular specialists. Surgical ventricular restoration adds no outcome advantage in ischemic heart failure over coronary artery bypass surgery alone. Novel medical therapies may include cytokine blockade and the vasodilator, relaxin. Although diastolic failure is prevalent, its clinical significance is unclear. Cardiac resynchronization reduces mortality and hospitalization. Perioperative enoximone facilitates beta-blockade for prophylaxis against myocardial ischemia. Heart failure still determines outcome in pulmonary embolism and cardiac surgery. The practice of ventricular assist devices continues to progress. A profile system based on urgency of mechanical support will guide future outcome assessment. Clinical scoring systems will guide the management of right heart failure. Device flow determines the risk of cerebral hyperperfusion and neurologic dysfunction. Regardless of device type, renal dysfunction remains an important outcome determinant. Postoperative heparinization is increasingly challenged because of the risks of bleeding and heparin-induced thrombocytopenia. The practice of heart transplantation continues to mature. The bicaval rather than the biatrial technique improves short-term outcome. Oral sildenafil is effective for pulmonary hypertension and right ventricular support. Although immunosuppression with tacrolimus is beneficial, sirolimus is less nephrotoxic and preserves coronary vasomotor function. The induction of immunosuppression may be modified as it has a weak evidence base. Psychosocial factors also continue to influence clinical outcome significantly. The future of heart failure treatment is bright with signs of active growth and progress in this vibrant subspecialty.
心力衰竭的治疗已经取得了重大进展；其阶段被定义为心血管专家的管理平台。与单独进行冠状动脉旁路手术相比，外科心室修复并不能为缺血性心力衰竭带来任何结果优势。新型医学疗法可能包括细胞因子阻断和血管扩张剂松弛素。尽管舒张性心力衰竭很常见，但它的临床意义尚不清楚。心脏再同步化可降低死亡率和住院率。围手术期依诺昔酮有助于预防心肌缺血的β受体阻滞剂。心力衰竭仍然决定着肺栓塞和心脏手术的结局。心室辅助装置的应用实践仍在不断发展。基于机械支持紧迫性的评分系统将指导未来的结果评估。临床评分系统将指导右心衰竭的管理。设备流量决定了大脑过度灌注和神经功能障碍的风险。无论设备类型如何，肾功能障碍仍然是一个重要的预后决定因素。由于出血和肝素诱导的血小板减少症的风险，术后肝素化越来越受到挑战。心脏移植的实践仍在不断成熟。与双房技术相比，腔静脉而非双房技术可改善短期结局。口服西地那非可有效治疗肺动脉高压和右心室支持。尽管他克莫司的免疫抑制作用有益，但西罗莫司的肾毒性较小，并能保留冠状动脉血管舒缩功能。免疫抑制的诱导可能会有所改变，因为其证据基础较弱。社会心理因素也继续对临床结果产生重大影响。心力衰竭治疗的未来充满希望，这个充满活力的亚专业领域显示出积极的增长和进步迹象。
