Botta Luca, De Chiara Benedetta, Macera Francesca, Cannata Aldo, Costetti Alessandro, Voltolini Alessandra, Moreo Antonella, Cipriani Manlio, Frigerio Maria, Russo Claudio Francesco
a Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department , Niguarda Hospital , Milano , Italy.
b Cardiology Unit, Cardio-Thoraco-Vascular Department , Niguarda Hospital , Milano , Italy.
Expert Rev Med Devices. 2017 Jun;14(6):423-437. doi: 10.1080/17434440.2017.1325318. Epub 2017 May 16.
Despite the improvements in medical and surgical treatments, the incidence of end-stage heart failure (ESHF) continues to increase. Different mechanical systems have been adopted to support failing left ventricles. Among continuous-flow devices, the HeartWare-HVAD was the first to use a centrifugal pump rather than an axial one. Areas covered: In this review article, we provide an overview of the HeartWare-HVAD as a ventricular assist device for ESHF, discussing indications, echocardiographic assessment, surgical techniques, outcomes, concerns and controversies. Scientific literature was reviewed with a MEDLINE search strategy combining 'HeartWare' or 'HVAD' with 'heart failure'. A total of 263 papers were found using the reported search. From these, 16 were identified to provide the best evidence on the subject reporting outcomes in ≥50 patients. Expert commentary: HeartWare-HVAD is a minute device that provides full circulatory support in patients with ESHF. Its main indication remains bridge to heart transplantation (HTx). Median sternotomy is the preferred technique of implantation although less invasive procedures have been described. Early outcomes are satisfactory. Nevertheless, some fearing complications still occur during the mid- and long-term follow-up. Further technical developments and optimal medical management will guarantee better outcomes.
尽管医学和外科治疗有所进步，但终末期心力衰竭（ESHF）的发病率仍在持续上升。人们采用了不同的机械系统来支持衰竭的左心室。在连续流装置中，HeartWare-HVAD是首个使用离心泵而非轴流泵的装置。涵盖领域：在这篇综述文章中，我们概述了HeartWare-HVAD作为ESHF的心室辅助装置，讨论了其适应证、超声心动图评估、手术技术、疗效、关注点及争议。采用将“HeartWare”或“HVAD”与“心力衰竭”相结合的MEDLINE检索策略对科学文献进行了综述。通过所报告的检索共找到263篇论文。其中，16篇被确定为能提供关于该主题的最佳证据，报告了≥50例患者的结局。专家评论：HeartWare-HVAD是一种小巧的装置，可为ESHF患者提供全循环支持。其主要适应证仍是作为心脏移植（HTx）的过渡。正中胸骨切开术是首选的植入技术，尽管也描述了侵入性较小的手术方法。早期疗效令人满意。然而，在中长期随访期间仍会出现一些令人担忧的并发症。进一步的技术发展和优化的医疗管理将确保更好的疗效。
