German Centre for Cardiovascular Research (DZHK), partner site, Berlin, Germany; Deutsches Herzzentrum, Berlin, Germany.
Deutsches Herzzentrum, Berlin, Germany; Cardio Centrum, Berlin, Germany.
Can J Cardiol. 2019 Apr;35(4):523-534. doi: 10.1016/j.cjca.2018.11.015. Epub 2018 Nov 29.
In carefully selected patients with ventricular assist devices (VADs), good long-term results after device weaning and explantation can be achieved when reverse remodelling and improvement of native cardiac function occur. Monitoring of cardiac size, geometry, and function after initial VAD implantation is necessary to identify such patients. Formal guidelines for recovery assessment in patients with VADs do not exist, and protocols for recovery assessment and criteria for device weaning and explantation vary among centres. Barriers to evaluation of cardiac recovery include technical problems in obtaining echo images in patients with VADs, time restrictions for necessary VAD reductions/interruptions during assessment, and regurgitant flow patterns that occur with interruption of continuous flow VADs. The few larger studies addressing cardiac recovery after VAD implantation employed varied study designs, limiting interpretation. Current clinical practice is guided largely by local practice patterns, case reports, and small case series, and the available body of research-consisting mostly of expert opinions-has not been systematically addressed. This summary reviews evidence and expert opinion on VAD-promoted cardiac recovery assessment, its reliability, and associated challenges.
在经过精心选择的心室辅助装置（VAD）患者中，当出现逆向重构和心脏功能改善时，可在撤机和移除装置后获得良好的长期效果。在初始 VAD 植入后，有必要监测心脏的大小、几何形状和功能，以识别出此类患者。目前不存在 VAD 患者恢复评估的正式指南，而且各中心的恢复评估方案和装置撤机及移除标准也存在差异。评估心脏恢复的障碍包括：VAD 患者获取超声心动图图像存在技术问题、评估期间必须减少/中断 VAD 的时间限制，以及中断连续血流 VAD 时会出现反流模式。少数较大的研究采用了不同的研究设计，从而限制了研究结果的解读。目前的临床实践主要受当地实践模式、病例报告和小病例系列的指导，而大部分由专家意见组成的现有研究并未得到系统的处理。本综述回顾了关于 VAD 促进的心脏恢复评估及其可靠性的证据和专家意见，以及相关挑战。
