Saia Francesco, Loforte Antonino, Pacini Davide
Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Cardiac Surgery Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
Cardiovasc Diagn Ther. 2021 Feb;11(1):292-300. doi: 10.21037/cdt-20-335.
The prevalence of heart failure (HF) continues to rise over time, with aging of the population and increased survival of incident cases. Major improvements occurred in drug therapy but morbidity and mortality of HF patients remain high. Some non-pharmacologic approaches to HF are already part of standard treatment for HF, including implantable cardioverter-defibrillators, cardiac resynchronization therapy (CRT) and left ventricular assist devices (LVADs). A number of transcatheter treatments and devices have been developed to improve management of valvular heart diseases (VHD), and some of them are being used or tested in specific HF conditions. For example, transcatheter aortic valve implantation (TAVI) to unload the left ventricle in patients with moderate aortic stenosis (AS) and HF or TAVI for severe aortic regurgitation (AR) in patients with LVADs. Similarly, percutaneous mitral valve repair can be used to improve prognosis and quality of life in patients with functional mitral valve regurgitation, and has been proposed as a bridge-to-LVAD or to heart transplant in selected patients. Other devices have been specifically developed for the treatment of chronic HF. In this review we describe the main devices used in the treatment of HF associated with aortic and mitral valve disease, as well as novel transcatheter interventions for chronic HF with different pathophysiologic targets.
随着人口老龄化和新发病例存活率的提高，心力衰竭（HF）的患病率持续上升。药物治疗有了重大进展，但HF患者的发病率和死亡率仍然很高。一些HF的非药物治疗方法已成为HF标准治疗的一部分，包括植入式心脏复律除颤器、心脏再同步治疗（CRT）和左心室辅助装置（LVAD）。已经开发了许多经导管治疗方法和装置来改善瓣膜性心脏病（VHD）的管理，其中一些正在特定的HF情况下使用或测试。例如，经导管主动脉瓣植入术（TAVI）用于减轻中度主动脉瓣狭窄（AS）和HF患者的左心室负荷，或用于LVAD患者的严重主动脉瓣反流（AR）的TAVI。同样，经皮二尖瓣修复可用于改善功能性二尖瓣反流患者的预后和生活质量，并已被提议作为选定患者LVAD或心脏移植的桥梁。其他装置是专门为治疗慢性HF而开发的。在本综述中，我们描述了用于治疗与主动脉瓣和二尖瓣疾病相关的HF的主要装置，以及针对具有不同病理生理靶点的慢性HF的新型经导管干预措施。
