Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
Curr Opin Cardiol. 2019 Mar;34(2):194-201. doi: 10.1097/HCO.0000000000000600.
Use of durable left ventricular assist devices (LVADs) has increased considerably in recent years because of the insufficient supply of donor hearts for cardiac transplantation and improvement in outcomes from refinements in technology. This review examines clinical utility of these devices and summarizes the most recent evidence supporting the use of LVAD therapy.
There continues to be significant advancements made in LVAD technology, which has resulted in improvements in the rates of adverse events and overall patient quality of life. Specifically, less invasive and improved surgical techniques have resulted in fewer incidence of pump thrombosis and stringent blood pressure management have been shown to significantly decrease stroke rates.
The continued advances in LVAD therapy have resulted in significant improvement in overall survival; however, complication rates remain relatively high. Future work will focus on improvements in adverse outcomes and ultimately the possibility that LVADs will be a viable alternative to transplantation in patients with end-stage heart failure.
由于供体心脏用于心脏移植的数量不足以及技术改进带来的结果改善,近年来耐用性左心室辅助装置(LVAD)的使用有了显著增加。本综述检查了这些设备的临床实用性,并总结了支持 LVAD 治疗的最新证据。
LVAD 技术不断取得重大进展,导致不良事件发生率和整体患者生活质量的提高。具体而言,侵入性较小和改进的手术技术导致泵血栓形成的发生率降低,严格的血压管理已被证明可显著降低中风发生率。
LVAD 治疗的持续进展导致整体生存率显著提高;然而,并发症发生率仍然相对较高。未来的工作将侧重于改善不良结局,最终有可能使 LVAD 成为终末期心力衰竭患者移植的可行替代方案。