Albert Chonyang L, Estep Jerry D
Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH, USA.
Curr Treat Options Cardiovasc Med. 2019 Aug 7;21(9):48. doi: 10.1007/s11936-019-0748-x.
This review will discuss key differences of third-generation left ventricular assist devices (LVADs), identify patient selection considerations to optimize post-implant clinical outcomes, and summarize key echocardiographic and hemodynamic parameters to guide device optimization.
There are major engineering differences between the third-generation LVADs which contribute to unique pump operational characteristics. Improved hemocompatibility has led to reduction in hemocompatibility-related adverse events (HRAEs), particularly for the Heartmate 3 pump. Having an optimal hemodynamic profile compared with not while on LVAD support defined by either echocardiography or right heart catheterization is associated with a more favorable event-free survival. With attentive patient selection, use of current third-generation LVADs, and appropriate use of echocardiography and invasive ramp studies, LVAD therapy will continue to improve survival and quality of life in select patients with advanced heart failure.
本综述将讨论第三代左心室辅助装置（LVAD）的关键差异，确定优化植入后临床结果的患者选择考量因素，并总结指导装置优化的关键超声心动图和血流动力学参数。
第三代LVAD之间存在重大工程差异，这导致了独特的泵运行特性。血液相容性的改善已使血液相容性相关不良事件（HRAE）减少，尤其是Heartmate 3泵。与未使用LVAD支持时相比，通过超声心动图或右心导管检查定义的具有最佳血流动力学特征与更有利的无事件生存率相关。通过精心的患者选择、使用当前的第三代LVAD以及适当使用超声心动图和有创斜坡研究，LVAD治疗将继续改善特定晚期心力衰竭患者的生存率和生活质量。
