Advanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Slovenia (G.P., B.V.).
Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, University of Texas Health Science Center at Houston (G.P., I.D.G., R.R.).
Circ Heart Fail. 2019 Feb;12(2):e005454. doi: 10.1161/CIRCHEARTFAILURE.118.005454.
Ventricular assist device (VAD) technology has evolved significantly over the past decades and currently represents one of the most important treatment strategies for patients with advanced chronic heart failure. There is increasing evidence that in selected patients undergoing long-term VAD support, improvement of myocardial structure and function may occur. However, there seems to be a significant discrepancy between structural and functional recovery of the failing myocardium, as only a small fraction of VAD-supported patients demonstrate reverse structural remodeling and eventually reach clinically significant and stable, functional improvement. More recently, cell therapy has gained a growing interest in the heart failure community because of its potential to augment reverse remodeling of the failing myocardium. Although theoretically the combination of long-term VAD support and cell therapy may offer significant advantages over using these therapeutic modalities separately, it remains largely unexplored. This review aims to summarize the current state of the art of the effects of VAD support and cell therapy on the reverse remodeling of the failing myocardium and to discuss the rationale for using a combined treatment strategy to further promote myocardial recovery in patients with advanced chronic heart failure.
心室辅助装置（VAD）技术在过去几十年中得到了显著发展，目前是治疗晚期慢性心力衰竭患者的最重要治疗策略之一。越来越多的证据表明，在接受长期 VAD 支持的选定患者中，心肌结构和功能可能会得到改善。然而，衰竭心肌的结构和功能恢复之间似乎存在显著差异，因为只有一小部分接受 VAD 支持的患者表现出反向结构重塑，最终达到临床上显著和稳定的功能改善。最近，细胞疗法因其增强衰竭心肌反向重塑的潜力而在心力衰竭领域引起了越来越多的关注。尽管从理论上讲，长期 VAD 支持和细胞疗法的联合使用可能比单独使用这些治疗方法具有显著优势，但这方面的研究仍在很大程度上尚未探索。本综述旨在总结 VAD 支持和细胞疗法对衰竭心肌反向重塑的影响的最新进展，并讨论联合治疗策略的合理性，以进一步促进晚期慢性心力衰竭患者的心肌恢复。
