Mohite Prashant N, Zych Bartlomiej, Banner Nicholas R, Simon Andre R
Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
Artif Organs. 2014 Apr;38(4):276-81. doi: 10.1111/aor.12157. Epub 2013 Aug 27.
Chronic heart failure is a progressive and eventually fatal illness. Although the disease cannot be cured and treatment is symptom oriented, most of the patients benefit from optimum medical treatment. Patients with rapid deterioration in chronic advanced heart failure refractory to medical treatment need inotropic support and may need intra-aortic balloon pump to maintain circulatory support, which of course cannot be prolonged beyond a certain limit. The outcome of heart transplant and long-term ventricular assist device (VAD) in such patients is poor. The short-term mechanical circulatory support (MCS) offered to such patients not only provides effective circulatory support and stabilizes them hemodynamically, but also halts the ensuing or reverts the established end-organ failure. As the name suggests, the short-term MCS offers support for the short term, usually less than a month. Although some patients with acute heart failure experience recovery of myocardial function with short-term MCS support, others become dependent. These patients, stabilized and "stuck" with short-term MCS, can be "rescued" with long-term VAD or heart transplantation. Both the procedures, when done in this special situation, have their inherent advantages, disadvantages, and complications and hence need the careful consideration about the choice of the procedure. We have tried to elucidate this situation by considering the advantages and disadvantages of both options.
慢性心力衰竭是一种进行性且最终致命的疾病。尽管这种疾病无法治愈且治疗以症状为导向，但大多数患者能从最佳药物治疗中获益。慢性晚期心力衰竭患者若病情迅速恶化且对药物治疗无效，需要正性肌力支持，可能还需要主动脉内球囊反搏来维持循环支持，当然这种支持不能超过一定期限。此类患者进行心脏移植和长期心室辅助装置（VAD）的效果不佳。为这些患者提供的短期机械循环支持（MCS）不仅能提供有效的循环支持并使他们的血流动力学稳定，还能阻止随后发生的或逆转已确立的终末器官功能衰竭。顾名思义，短期MCS提供短期支持，通常少于一个月。虽然一些急性心力衰竭患者在短期MCS支持下心肌功能得以恢复，但其他患者会产生依赖。这些通过短期MCS稳定病情并“依赖”该支持的患者，可以通过长期VAD或心脏移植来“挽救”。在这种特殊情况下进行这两种手术，都有其固有的优点、缺点和并发症，因此需要仔细考虑手术方式的选择。我们试图通过考虑两种选择的优缺点来阐明这种情况。
