Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Health System, Geriatric Research, Education and Clinical Center, VeteransAffairs Ann Arbor Healthcare System, 2215 Fuller Road, GRECC (11G), Ann Arbor, MI 48105, USA.
J Am Geriatr Soc. 2012 Jan;60(1):145-50. doi: 10.1111/j.1532-5415.2011.03740.x.
Left ventricular assist devices (LVADs) are approved as "destination therapy" (permanent use without plans for transplantation) in individuals with advanced heart failure who are not candidates for a cardiac transplant; as such, these devices are increasingly being used in older adults. Although LVADs have been shown to increase quality of life and survival, the associated treatment burdens and complications deserve careful consideration. The current study illustrates myriad clinical challenges that can arise during long-term mechanical support using an older adult case history. Current data on LVAD use in older adults is reviewed, and a discussion of relevant points to consider before LVAD implantation in older adults, including advance care planning, assessment of gait and cognition, and the potential for substantial caregiver burden, is undertaken.
左心室辅助装置（LVAD）被批准用于晚期心力衰竭且不符合心脏移植条件的患者作为“终末期治疗”（永久性使用，不考虑移植）；因此，这些装置越来越多地用于老年人。尽管 LVAD 已被证明可以提高生活质量和生存率，但相关的治疗负担和并发症值得仔细考虑。本研究通过老年患者的病例说明了在长期机械支持过程中可能出现的多种临床挑战。本文回顾了 LVAD 在老年人中的应用数据，并讨论了在老年患者中植入 LVAD 之前需要考虑的相关要点，包括预先护理计划、步态和认知评估，以及潜在的大量护理人员负担。
