Ujeyl A, Krüger M
Abteilung für Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland.
Herz. 2015 Nov;40(7):972-9. doi: 10.1007/s00059-015-4365-5.
The use of left ventricular assist devices (LVAD) as a treatment for severe heart failure has gained momentum in recent years. Even at this stage the number of worldwide LVAD implantations far exceeds the volume of heart transplantations in view of the chronic shortage of donor organs. Third generation continuous flow assist devices have helped to improve survival, quality of life and symptom burden of heart failure patients in comparison to a regimen of optimal medication management. Alongside bridging to transplantation, destination therapy has become an established strategy of LVAD implantation. A careful patient selection process is crucial for a good clinical outcome after device implantation and risk assessment for postoperative right ventricular failure is of particular importance in this context. The rate of hospitalization during LVAD support is still high, despite the step-wise attempts to widen the indications to less severely ill heart failure patients. An effective perioperative and postoperative management will help to lower the incidence of complications (e.g. bleeding, infections, thromboembolic events and right ventricular failure) and to improve the encouraging results of mechanical circulatory support.
近年来，使用左心室辅助装置（LVAD）治疗严重心力衰竭的情况日益普遍。即便在现阶段，鉴于供体器官长期短缺，全球LVAD植入数量远远超过心脏移植数量。与最佳药物治疗方案相比，第三代连续血流辅助装置有助于提高心力衰竭患者的生存率、生活质量并减轻症状负担。除了过渡到移植，目标治疗已成为LVAD植入的既定策略。精心的患者选择过程对于装置植入后的良好临床结果至关重要，在此背景下，术后右心室衰竭的风险评估尤为重要。尽管逐步尝试扩大适应证至病情较轻的心力衰竭患者，但LVAD支持期间的住院率仍然很高。有效的围手术期和术后管理将有助于降低并发症（如出血、感染、血栓栓塞事件和右心室衰竭）的发生率，并改善机械循环支持令人鼓舞的效果。
