Stewart Garrick C, Ambardekar Amrut V, Kittleson Michelle M
Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
Division of Cardiology, University of Colorado, Aurora, CO, USA.
Curr Heart Fail Rep. 2017 Dec;14(6):498-506. doi: 10.1007/s11897-017-0363-7.
Extended survival with LVADs has generated interest in implantation for ambulatory patients with advanced heart failure (HF) prior to dependence on inotropes, though we remain limited in our ability to define and advance indications in this less sick advanced HF population.
The MedaMACS and ROADMAP studies have informed prognosis and decision-making for ambulatory patients with advanced HF. Sicker INTERMACS profiles are consistently associated with high risk of death or rescue LVAD. Appropriately selected patients in profile 4 should be considered for LVADs based on their high mortality and poor quality of life. These studies also shed light on discordant perceptions of HF disease severity between patients and their physicians. For ambulatory patients with HF not at imminent risk of death, shared decision-making about LVAD requires measured and individualized consideration of risk and benefit beyond survival. Future studies, including the ongoing REVIVAL study, should provide additional prognostic information in this patient population and should aid patients, caregivers, and physicians as they contemplate complex decisions regarding LVAD therapy.
左心室辅助装置（LVAD）的长期存活引发了人们对在晚期心力衰竭（HF）患者依赖血管活性药物之前为其植入该装置以实现门诊治疗的兴趣，尽管我们在明确和推进这一病情较轻的晚期HF患者群体的适应症方面能力有限。
MedaMACS和ROADMAP研究为晚期HF门诊患者的预后和决策提供了依据。病情较重的INTERMACS分级与死亡或挽救性LVAD的高风险持续相关。基于其高死亡率和低生活质量，对于分级为4级的适当入选患者应考虑植入LVAD。这些研究还揭示了患者与其医生对HF疾病严重程度的不同认知。对于没有即刻死亡风险的HF门诊患者，关于LVAD的共同决策需要对生存之外的风险和益处进行慎重且个性化的考量。未来的研究，包括正在进行的REVIVAL研究，应为本患者群体提供更多预后信息，并应在患者、护理人员和医生考虑有关LVAD治疗的复杂决策时提供帮助。
