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目标治疗:左心室辅助装置治疗心力衰竭患者的新金标准疗法。

Destination therapy: the new gold standard treatment for heart failure patients with left ventricular assist devices.

作者信息

Yamakawa Michael, Kyo Shunei, Yamakawa Sean, Ono Minoru, Kinugawa Koichiro, Nishimura Takashi

机构信息

Department of Therapeutic Strategy for Heart Failure, University of Tokyo Hospital, Tokyo, Japan.

出版信息

Gen Thorac Cardiovasc Surg. 2013 Mar;61(3):111-7. doi: 10.1007/s11748-012-0181-5. Epub 2012 Dec 21.

Abstract

Heart failure continues to be a growing health problem, eluding large-scale improvement and treatment. Cardiac transplantation has been the gold standard treatment with high post-transplant survival rates and relatively good quality of life. However, there has been an extreme shortage of organ donations, limiting transplants to only a very small portion of patients with the condition. This led to a growing interest in alternative options for the increasing population of patients who are waitlisted or ineligible for transplantation. In recent years, ventricular assist device (VAD) technologies have advanced from pulsatile blood pumps to continuous-flow pumps that have demonstrated unprecedented post-implantation survival rates. The HeartMate II, the only commercially available, continuous flow left ventricular assist device (LVAD) in the United States and Europe, has been implanted in over 10,000 patients worldwide, setting a benchmark for biomedical modalities of advanced heart failure treatment. Thanks to the successes of contemporary LVADs, patients are able to enjoy a better lifestyle, with a significantly prolonged life span and the ability to regularly partake in physical activities. In this new biomedical generation, the usage of LVADs has begun to expand towards the treatment for a wider range of heart conditions, including earlier stages of heart failure. In fact, LVAD implantations have surpassed the number of transplants taken place annually. An increasing number of patients are considering the permanent, circulatory support with an LVAD, namely destination therapy, as a promising option for treating heart failure.

摘要

心力衰竭仍然是一个日益严重的健康问题,难以得到大规模的改善和治疗。心脏移植一直是金标准治疗方法,移植后生存率高,生活质量相对较好。然而,器官捐赠极度短缺,限制了移植仅适用于极少数患有该疾病的患者。这使得对于越来越多被列入等待名单或不符合移植条件的患者,人们对替代方案的兴趣日益浓厚。近年来,心室辅助装置(VAD)技术已从搏动式血泵发展到连续流泵,后者已显示出前所未有的植入后生存率。HeartMate II是美国和欧洲唯一可商购的连续流左心室辅助装置(LVAD),已在全球10000多名患者中植入,为晚期心力衰竭治疗的生物医学模式树立了标杆。得益于当代LVAD的成功,患者能够享受更好的生活方式,寿命显著延长,并有能力定期参加体育活动。在这个新的生物医学时代,LVAD的使用已开始扩大到治疗更广泛的心脏疾病,包括心力衰竭的早期阶段。事实上,LVAD植入的数量已超过每年进行的移植数量。越来越多的患者将使用LVAD进行永久性循环支持,即目标治疗,视为治疗心力衰竭的一个有前景的选择。

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