Rojas S V, Haverich A
Klinik für Herz‑, Thorax‑, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Chirurg. 2019 Feb;90(2):110-116. doi: 10.1007/s00104-018-0774-3.
End-stage heart failure is one of the leading causes of death in Germany. Cardiac transplantation is still considered the gold standard for the treatment of terminal heart failure; however, there is a discrepancy between patients on the waiting list and yearly performed transplantations. As an alternative, ventricular assist devices have achieved a high level of importance but treatment is still associated with challenges. Novel systems as well as innovative surgical techniques contribute to improving the safety and effectiveness of the treatment.
To generate an overview of current surgical innovations in cardiac transplantation and mechanical circulatory support.
A Medline search was conducted regarding innovations in cardiac transplantation and mechanical circulatory support.
Not only the number of yearly performed cardiac transplantations has changed but also recipient profiles. While in the pioneering era of transplantation the typical candidate was young, not previously operated on and with lower levels of comorbidities, today's patients are significantly older, have been fitted with ventricular assist devices and have increased operative risk profiles. Modern methods of organ preservation enable longer transportation and operation times as well as an improved assessment of graft function and perspectives for graft optimization in the future. In the area of ventricular assist devices, advances in the reduction of the stroke rate seem to have been achieved by the latest generation devices. From a surgical perspective, less invasive surgical techniques with promising initial results have been established at numerous centers.
终末期心力衰竭是德国主要的死亡原因之一。心脏移植仍然被认为是终末期心力衰竭治疗的金标准；然而，等待名单上的患者与每年进行的移植手术数量之间存在差异。作为一种替代方案，心室辅助装置已变得极为重要，但治疗仍面临挑战。新型系统以及创新的手术技术有助于提高治疗的安全性和有效性。
综述心脏移植和机械循环支持领域当前的手术创新。
对心脏移植和机械循环支持方面的创新进行了Medline检索。
不仅每年进行的心脏移植手术数量发生了变化，受体情况也有所改变。在移植的开创时代，典型的候选者是年轻、未曾接受过手术且合并症较少的患者，而如今的患者年龄显著更大，已安装心室辅助装置且手术风险更高。现代的器官保存方法能够延长运输和手术时间，同时改善对移植物功能的评估以及未来移植物优化的前景。在心室辅助装置领域，最新一代装置似乎在降低卒中率方面取得了进展。从手术角度来看，许多中心已经确立了具有初步良好效果的微创外科技术。
