Elliott Andrea M, Lampert Brent C
Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Heart Failure & Transplantation, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA.
Curr Heart Fail Rep. 2016 Feb;13(1):13-9. doi: 10.1007/s11897-016-0279-7.
Heart failure is a common condition with significant morbidity and mortality. Pharmacologic and device therapies have resulted in substantial improvements in heart failure outcomes. Despite optimal therapy, 10 % of patients progress to advanced HF, characterized by progressive symptoms, poor quality of life, and poor prognosis. The "gold-standard" treatment of advanced heart failure remains cardiac transplantation. However, the number of patients with advanced heart failure far exceeds available donor organs. Left ventricular assist devices (LVADs) were initially developed to bridge patients with hemodynamic collapse to transplantation. Their use resulted in marked improvements in survival and quality of life in select patients giving rise to increased and expanded overall implantation. Despite these improvements, patient selection and timing for LVAD therapy is still evolving. In this article, we will review a brief history of LVADs, examine patient selection, and explore the currently debated expansion of LVADs to "less sick" patients.
心力衰竭是一种常见疾病，具有较高的发病率和死亡率。药物治疗和器械治疗已使心力衰竭的治疗效果有了显著改善。尽管进行了最佳治疗，仍有10%的患者进展为晚期心力衰竭，其特征为症状进行性加重、生活质量差和预后不良。晚期心力衰竭的“金标准”治疗仍然是心脏移植。然而，晚期心力衰竭患者的数量远远超过了可用的供体器官数量。左心室辅助装置（LVAD）最初是为将血流动力学崩溃的患者过渡到移植而开发的。其应用使部分患者的生存率和生活质量有了显著改善，从而导致总体植入量增加和范围扩大。尽管有这些改善，但LVAD治疗的患者选择和时机仍在不断发展。在本文中，我们将回顾LVAD的简要历史，研究患者选择，并探讨目前关于将LVAD扩展应用于“病情较轻”患者的争议。
