Brown Matthew A, Sheikh Farooq H, Ahmed Sara, Najjar Samer S, Molina Ezequiel J
Georgetown University School of Medicine Washington DC.
MedStar Washington Hospital Center Washington DC.
J Am Heart Assoc. 2021 Aug 3;10(15):e019376. doi: 10.1161/JAHA.120.019376. Epub 2021 Jul 26.
Left ventricular assist devices (LVAD) are increasingly being used as destination therapy in patients with Stage D heart failure. It has been reported that a majority of patients who receive a durable LVAD (dLVAD) present in cardiogenic shock due to decompensated heart failure (ADHF-CS). As it stands, there is no consensus on the optimal management strategy for patients presenting with ADHF. Bridging with intra-aortic balloon pumps (IABPs) continues to be a therapeutic option in patients with hemodynamic instability due to cardiogenic shock. The majority of data regarding the use of IABP in cardiogenic shock come from studies in patients presenting with acute myocardial infarction with cardiogenic shock and demonstrates that there is no benefit of routine IABP use in this patient population. However, the role of IABPs as a bridge to dLVAD in ADHF-CS has yet to be determined. The hemodynamic changes seen in acute myocardial infarction with cardiogenic shock are known to be different and more acutely impaired than those presenting with ADHF-CS as evidenced by differences in pressure/volume loops. Thus, data should not be extrapolated across these 2 very different disease processes. The aim of this review is to describe results from contemporary studies examining the use of IABPs as a bridge to dLVAD in patients with ADHF-CS. Retrospective evidence from large registries suggests that the use of IABP as a bridge to dLVAD is feasible and safe when compared with other platforms of temporary mechanical circulatory support. However, there is currently a paucity of high-quality evidence examining this increasingly important clinical question.
左心室辅助装置（LVAD）越来越多地被用作D期心力衰竭患者的终末期治疗手段。据报道，大多数接受耐用型LVAD（dLVAD）的患者因失代偿性心力衰竭（ADHF-CS）导致心源性休克。目前，对于ADHF患者的最佳管理策略尚无共识。对于因心源性休克导致血流动力学不稳定的患者，使用主动脉内球囊反搏（IABP）进行过渡治疗仍是一种选择。关于IABP在心源性休克中应用的大多数数据来自急性心肌梗死合并心源性休克患者的研究，这些研究表明，在这一患者群体中常规使用IABP并无益处。然而，IABP作为ADHF-CS患者过渡到dLVAD的作用尚未确定。急性心肌梗死合并心源性休克时出现的血流动力学变化与ADHF-CS患者不同，且更为严重，压力/容积环的差异证明了这一点。因此，不应将这些数据外推到这两种截然不同的疾病过程中。本综述的目的是描述当代研究中关于IABP作为ADHF-CS患者过渡到dLVAD的应用结果。大型登记处的回顾性证据表明，与其他临时机械循环支持平台相比，使用IABP作为过渡到dLVAD的手段是可行且安全的。然而，目前缺乏高质量的证据来研究这个日益重要的临床问题。
