Hetzer Roland, Javier Mariano Francisco Del Maria, Wagner Frank, Loebe Matthias, Javier Delmo Eva Maria
Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany.
Charité Research Organization, Universitätsmedizin Berlin-Charité, Berlin, Germany.
Cardiovasc Diagn Ther. 2021 Feb;11(1):213-225. doi: 10.21037/cdt-20-285.
Over time, various surgical treatment strategies have evolved to manage advanced heart failure (HF). Scientific and technological breakthroughs through the last 50 years have put forward various surgical alternatives to patients with advanced HF encompassing surgical ventricular restoration to surgical gene therapy and stem cell replacement of the diseased ventricles. Organ-saving surgical options which used to be promising included dynamic cardiomyoplasty, partial resection of ventricle and cardiac wrapping with Acorn CorCap cardiac support device. These procedures were eventually abandoned due to negative outcomes and without proven disadvantages. Another organ-saving surgical option currently being considered but still make little sense is cardiac regeneration by stem cell therapy, i.e., cardiomyocyte restoration and replacement. Presently, the organ-saving surgical alternatives to treat end-stage HF are revascularization for ischemic cardiomyopathy, mitral valve surgery (repair or replacement) for ischemic mitral incompetence (IMI), left ventricular (LV) aneurysmectomy (surgical ventricular restoration) and mitral valve repair for IMI. These aforementioned procedures have become quite established approaches and with increasing experience are continuously being modified to improve outcome. Various mechanical circulatory support systems have emerged over time to improve functional status of patients with advanced HF, either as a bridge to heart transplantation or as a bridge to myocardial recovery. Likewise offered in those with contraindications to transplantation. Ventricular assist devices (VAD) can keep patients alive until an eventual transplantation. This article reviews the variety of the myriad of alternative organ-saving surgical alternatives that have been available or are currently available provided to patients with end-stage HF, their advantages and deficiencies, as well as prospects in HF therapy.
随着时间的推移，各种手术治疗策略不断发展，以应对晚期心力衰竭（HF）。过去50年的科技突破为晚期HF患者提出了各种手术选择，从手术性心室修复到手术基因治疗以及对患病心室进行干细胞置换。曾经很有前景的保留器官的手术选择包括动态心肌成形术、心室部分切除术以及使用橡果CorCap心脏支持装置进行心脏包裹。这些手术最终因负面结果且无确凿益处而被放弃。目前正在考虑但仍意义不大的另一种保留器官的手术选择是通过干细胞疗法进行心脏再生，即心肌细胞修复和置换。目前，治疗终末期HF的保留器官的手术选择包括针对缺血性心肌病的血运重建、针对缺血性二尖瓣反流（IMI）的二尖瓣手术（修复或置换）、左心室（LV）动脉瘤切除术（手术性心室修复）以及针对IMI的二尖瓣修复。上述这些手术已成为相当成熟的方法，并且随着经验的增加不断进行改进以改善治疗效果。随着时间的推移，出现了各种机械循环支持系统，以改善晚期HF患者的功能状态，要么作为心脏移植的桥梁，要么作为心肌恢复的桥梁。同样也为那些有移植禁忌症的患者提供。心室辅助装置（VAD）可以维持患者生命直至最终进行移植。本文回顾了为终末期HF患者提供的众多现有的或当前可用的保留器官的手术替代方案的种类、它们的优缺点以及HF治疗的前景。
