Moritz A, Wolner E, Nose Y
II. Chirurgische Universitätsklinik, Wien.
Wien Klin Wochenschr. 1988 Mar 18;100(6):161-7.
Clinical experience with the artificial heart now comprises 520 cases. 390 patients had to be supported mechanically when they could not be weaned off cardiopulmonary bypass. 177 (45%) subsequently had their assist devices removed and 100 (25.4%) were discharged. Good functional results were achieved, since 30 of 36 long-term survivors are in NYHA class I or II. 140 underwent two-stage cardiac transplantation. Of 63 patients implanted with a ventricular assist device (VAD) 71% were transplanted and 51% survived. A total artificial heart (TAH) was used in 77 cases, 81% were transplanted and 47% survived. Five patients received TAH implantations as a permanent replacement of the failing heart. Though the clinical courses were complicated by strokes and infections and the patients were tethered to bulky drive units, it was proven that the TAH may sustain human life for up to 622 days, much longer than so far achieved in animal experiments. Improvements of the atrial connectors and valve holding components and of the biocompatibility of the blood contacting surfaces should overcome the complication of thromboembolism. Fully implantable devices which are currently being developed will avoid the problem of drive-line infections and provide fuller mobility to the patient.
目前人工心脏的临床经验已涵盖520例病例。390例患者在无法脱离体外循环时需要机械支持。其中177例（45%）随后移除了辅助装置，100例（25.4%）出院。取得了良好的功能结果，因为36例长期存活者中有30例处于纽约心脏协会（NYHA）心功能I级或II级。140例患者接受了两阶段心脏移植。在63例植入心室辅助装置（VAD）的患者中，71%接受了移植，51%存活。77例使用了全人工心脏（TAH），81%接受了移植，47%存活。5例患者接受TAH植入作为衰竭心脏的永久性替代。尽管临床过程因中风和感染而复杂化，且患者与庞大的驱动装置相连，但已证明TAH可维持人类生命长达622天，比迄今为止在动物实验中所达到的时间长得多。心房连接器、瓣膜固定部件以及血液接触表面生物相容性的改进应能克服血栓栓塞并发症。目前正在研发的完全可植入装置将避免驱动线感染问题，并为患者提供更大的行动自由度。
