Moosdorf R
Klinik für Herz- und thorakale Gefäßchirurgie, UKGM - Universitätsklinik Marburg, Baldingerstr. 1, 35033, Marburg, Deutschland.
Herz. 2012 Dec;37(8):869-74. doi: 10.1007/s00059-012-3702-1.
The advances in the treatment of many different heart diseases have on the one side led to a significant prolongation of life expectancy but have also contributed to an increase of patients with heart failure. This tendency is supported even more so by the demographic development of our population. The replacement of insufficient organs has always been in the focus of medical research. In the 1960's Shumway and Lower developed the technique of cardiac transplantation and also worked intensively on the treatment and diagnosis of rejection. However, it was Barnard who, in 1967 performed the first human cardiac transplantation. Other centers followed worldwide but the mortality was high and the new therapy was controversially discussed in many journals. By the introduction of cyclosporin as a new immunosuppressive agent in 1978, results improved rapidly and cardiac transplantation became an accepted therapeutic option for patients with end stage heart failure and also for children and newborns with congenital heart defects. Today, with newer immunosuppressive regimens and improved techniques, cardiac transplantation offers excellent results with a long-term survival of nearly 50% of patients after 15 years and among the pediatric population even after 20 years. However, the donor organ shortage as well as the increasing number of elderly patients with end stage heart failure has necessitated work on other alternatives. Neither stem cell transplantation nor xenotransplantation of animal organs are yet an option and there are still some obstacles to be overcome. In contrast, the development of so-called artificial hearts has made significant progress. While the first implants of totally artificial hearts were associated with many comorbidities and patients were seriously debilitated, new devices today offer a reasonable quality of life and long-term survival. Most of these systems are no longer replacing but mainly assisting the heart, which remains in place. These ventricular assist devices have been used as a bridge to transplantation for a long time and are now also offered as a destination therapy for patients who for a variety of reasons are no longer amenable to heart transplantation. Further miniaturization and a decrease of the costs will make these devices a realistic alternative to a sole medical therapy and studies have already proven the superiority in terms of survival as well as rehospitalization rates. However, at present they are still not an alternative to heart transplantation.
许多不同心脏病治疗方法的进步一方面显著延长了预期寿命，但也导致心力衰竭患者数量增加。我们人口的人口结构发展进一步加剧了这种趋势。替换功能不全的器官一直是医学研究的重点。20世纪60年代，舒梅克和洛厄开发了心脏移植技术，并深入研究排斥反应的治疗和诊断。然而，是巴纳德在1967年进行了首例人体心脏移植。世界各地的其他中心纷纷效仿，但死亡率很高，新疗法在许多期刊上引发了争议性讨论。1978年引入环孢素作为一种新的免疫抑制剂后，结果迅速改善，心脏移植成为终末期心力衰竭患者以及患有先天性心脏缺陷的儿童和新生儿可接受的治疗选择。如今，随着更新的免疫抑制方案和改进的技术，心脏移植取得了出色的效果，15年后近50%的患者长期存活，儿科患者甚至在20年后仍能存活。然而，供体器官短缺以及终末期心力衰竭老年患者数量的增加使得有必要研究其他替代方案。干细胞移植和动物器官异种移植都还不是可行的选择，仍有一些障碍需要克服。相比之下，所谓人工心脏的发展取得了重大进展。虽然最初植入全人工心脏伴随着许多合并症，患者严重虚弱，但如今的新设备提供了合理的生活质量和长期存活。这些系统中的大多数不再是替换心脏，而是主要辅助仍保留原位的心脏。这些心室辅助装置长期以来一直被用作移植的桥梁，现在也作为一种终末治疗方法提供给因各种原因不再适合心脏移植的患者。进一步的小型化和成本降低将使这些装置成为单纯药物治疗的现实替代方案，研究已经证明在生存率和再住院率方面它们具有优越性。然而，目前它们仍然不是心脏移植的替代方案。
