Hetzer Roland, Javier Mariano Francisco Del Maria, Dandel Michael, Loebe Matthias, Javier Delmo Eva Maria
Department of Cardiothoracic and Vascular Surgery, Cardio Centrum Berlin, Berlin, Germany.
Thoracic Transplant and Mechanical Support, Miami Transplant Institute, Memorial Jackson Health System, University of Miami, Miami, FL, USA.
Cardiovasc Diagn Ther. 2021 Feb;11(1):309-322. doi: 10.21037/cdt-20-283.
The joint efforts in the fields of surgery, medicine and biomedical engineering, sponsored by both the government and the industry, have led to the development of mechanical support devices that can provide reliable circulatory support, which can temporarily support a patient's circulation until either the heart recovers or until a new heart can be transplanted or permanently replace a failed heart. Their development has been driven by the shortage of donor organs. Various systems have eventually evolved for short or long-term support of patients suffering from cardiogenic and/or advanced heart failure (HF). Over time, several have been withdrawn from the market due to high rate of thromboembolism and pump-related complications, but many others remained with modern principles of circulatory support proved to be durable and reliable. Hopefully, the ever-evolving technology will yield several devices aimed at their miniaturization, with an energy supply without risk of infection, a system which is simple to implant and to exchange, minimalization of thrombus formation by optimal interior pump design, new antithrombotic medications and a system with demand-based pump activity. It is important to remember that such devices are only implanted to keep a patient alive or in an immediate life-threatening stage. In such circumstances, attribution of aforementioned difficulties to pump limitations or to advanced disease states remains difficult. In the coming years, ventricular assist devices (VADs) could be the most common surgical preference for treating severe HF.
在政府和行业的支持下，外科、医学和生物医学工程领域的共同努力推动了机械支持设备的发展，这些设备能够提供可靠的循环支持，可暂时维持患者的血液循环，直至心脏恢复或能够进行心脏移植，或者永久性替代衰竭的心脏。供体器官的短缺推动了它们的发展。最终，各种系统得以发展，用于短期或长期支持心源性和/或晚期心力衰竭（HF）患者。随着时间的推移，一些系统因血栓栓塞和泵相关并发症发生率高而退出市场，但许多其他系统凭借经证明持久可靠的现代循环支持原理得以留存。有望不断发展的技术将催生多种旨在实现小型化的设备，具备无感染风险的能量供应、易于植入和更换的系统、通过优化内部泵设计将血栓形成降至最低、新型抗血栓药物以及具备按需泵活动的系统。重要的是要记住，此类设备仅在患者处于危及生命的阶段或为维持生命时才植入。在这种情况下，将上述困难归因于泵的局限性还是晚期疾病状态仍很困难。在未来几年，心室辅助装置（VAD）可能成为治疗严重HF最常见的手术选择。
