Silvestry Scott
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, USA.
Mo Med. 2012 Jul-Aug;109(4):288-94.
Heart failure is a major healthcare problem associated with morbidity and mortality. Despite progress in treatments, the prognosis of heart failure remains poor. Standard treatments for heart failure include medical therapy, resynchronization therapy, and cardiac surgery. Heart failure teams providing guideline based care assist in the optimal management for advanced heart failure. Progression of heart failure despite optimal management may be treated with heart transplant. In non-transplant eligible patients, implantable left ventricular assist devices (LVADs) may improve patients 'quality of life and survival. Advances in LVADs, including smaller size, increased device durability, and (near) totally implantable devices, may enable LVADs to become an option in less sick patients. Evolving therapeutics such as stem cells and novel therapeutics may be combined with LVADs to allow myocardial recovery. This article will review current and developing strategies in the surgical management of heart failure with an emphasis on LVAD therapy.
心力衰竭是一个与发病率和死亡率相关的重大医疗保健问题。尽管在治疗方面取得了进展，但心力衰竭的预后仍然很差。心力衰竭的标准治疗方法包括药物治疗、心脏再同步治疗和心脏手术。提供基于指南护理的心力衰竭治疗团队有助于对晚期心力衰竭进行最佳管理。尽管进行了最佳管理，但心力衰竭仍进展的情况可通过心脏移植进行治疗。在不符合移植条件的患者中，植入式左心室辅助装置（LVAD）可能会改善患者的生活质量和生存率。LVAD的进展，包括尺寸更小、设备耐用性提高以及（近乎）完全可植入设备，可能会使LVAD成为病情较轻患者的一种选择。不断发展的治疗方法，如干细胞和新型疗法，可能与LVAD联合使用，以促进心肌恢复。本文将综述心力衰竭外科治疗的当前和发展策略，重点是LVAD治疗。
