Felix S E A, de Jonge N, Caliskan K, Birim O, Damman K, Kuijpers M, Tops L F, Palmen M, Ramjankhan F Z
Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Neth Heart J. 2020 Aug;28(Suppl 1):115-121. doi: 10.1007/s12471-020-01449-3.
In patients with end-stage heart failure, advanced therapies such as heart transplantation and long-term mechanical circulatory support (MCS) with a left ventricular assist device (LVAD) have to be considered. LVADs can be implanted as a bridge to transplantation or as an alternative to heart transplantation: destination therapy. In the Netherlands, long-term LVAD therapy is gaining importance as a result of increased prevalence of heart failure together with a low number of heart transplantations due to shortage of donor hearts. As a result, the difference between bridge to transplantation and destination therapy is becoming more artificial since, at present, most patients initially implanted as bridge to transplantation end up receiving extended LVAD therapy. Following LVAD implantation, survival after 1, 2 and 3 years is 83%, 76% and 70%, respectively. Quality of life improves substantially despite important adverse events such as device-related infection, stroke, major bleeding and right heart failure. Early referral of potential candidates for long-term MCS is of utmost importance and positively influences outcome. In this review, an overview of the indications, contraindications, patient selection, clinical outcome and optimal time of referral for long-term MCS is given.
对于终末期心力衰竭患者，必须考虑诸如心脏移植和使用左心室辅助装置（LVAD）的长期机械循环支持（MCS）等先进疗法。LVAD可作为移植桥梁植入，或作为心脏移植的替代方案：目标治疗。在荷兰，由于心力衰竭患病率上升以及供体心脏短缺导致心脏移植数量减少，长期LVAD治疗正变得越来越重要。因此，移植桥梁与目标治疗之间的区别变得越来越人为，因为目前，大多数最初作为移植桥梁植入的患者最终都接受了延长的LVAD治疗。LVAD植入后，1年、2年和3年的生存率分别为83%、76%和70%。尽管存在与装置相关的感染、中风、大出血和右心衰竭等重要不良事件，但生活质量仍有显著改善。尽早将潜在候选人转介至长期MCS至关重要，并对治疗结果产生积极影响。在本综述中，给出了长期MCS的适应症、禁忌症、患者选择、临床结果和最佳转介时间的概述。
