Krabatsch T, Schweiger M, Stepanenko A, Drews T, Potapov E, Pasic M, Weng Y, Huebler M, Hetzer R
Deutsches Herzzentrum Berlin, Deutschland.
Herz. 2011 Oct;36(7):622-9. doi: 10.1007/s00059-011-3509-5.
In recent years, ventricular assist devices (VAD) supporting the left (LVAD), the right (RVAD) or both ventricles (BVAD) have rapidly emerged as the standard of care for advanced heart failure patients. Both the numbers and ages of patients in which they are used are rising worldwide, especially when used as a permanent support (bridge to destination, BTD). Due to the continuing lack of donor organs, these devices now represent a viable alternative to bridge patients to transplantation (BTT), with a 1-year survival rate of 86%. BTD, especially in long-term support, might be a valid, and the sole, option for those patients in whom heart transplantation is contraindicated. Patient selection, pre- and intra-operative preparation, as well as the timing of VAD implantation are important factors critical to successful circulatory support. While BTT remains the goal in the majority of patients, the number of permanent VADs (i. e. BTD) is rising significantly. Although explantation of a VAD system as a bridge to recovery (BTR) can be considered in only a small number of patients, it represents a very special part of this therapy modality.
近年来，支持左心室（左心室辅助装置，LVAD）、右心室（右心室辅助装置，RVAD）或双心室（双心室辅助装置，BVAD）的心室辅助装置已迅速成为晚期心力衰竭患者的标准治疗手段。在全球范围内，使用这些装置的患者数量和年龄都在增加，尤其是在作为永久性支持手段（过渡到终点治疗，BTD）使用时。由于供体器官持续短缺，这些装置现在成为将患者过渡到移植（过渡到移植治疗，BTT）的可行替代方案，1年生存率为86%。对于那些心脏移植禁忌的患者，BTD，尤其是长期支持，可能是一个有效的、也是唯一的选择。患者选择、术前和术中准备以及心室辅助装置植入时机是成功进行循环支持的关键因素。虽然BTT仍然是大多数患者的目标，但永久性心室辅助装置（即BTD）的数量正在显著增加。虽然只有少数患者可以考虑将心室辅助装置系统作为过渡到恢复（过渡到恢复治疗，BTR）而取出，但这是这种治疗方式中非常特殊的一部分。
