2nd Section of Cardiology, Heart Failure and Transplant Unit, DeGasperis CardioCenter, Niguarda Great Metropolitan Hospital, Milan, Italy.
Heart Fail Clin. 2021 Oct;17(4):619-634. doi: 10.1016/j.hfc.2021.05.007. Epub 2021 Jul 22.
Left ventricular assist devices (LVADs) are indicated in inotrope-dependent heart failure (HF) patients with pure or predominant LV dysfunction. Survival benefit is less clear in ambulatory, advanced HF. Timing is crucial: early, unnecessary exposure to the risks of surgery, and device-related complications (infections, stroke, and bleeding) should be weighed against the probability of dying or developing irreversible right ventricular and/or end-organ dysfunction while deferring implant. The interplay between LVAD and heart transplantation depends largely on donor availability and allocation rules. Postoperatively, quality of life depends on patients' expectations and is influenced by complications. Patients' preferences, prognosis, and alternative options-including palliation-should be openly discussed and reviewed before and after the operation.
左心室辅助装置（LVAD）适用于依赖正性肌力药物的心力衰竭（HF）患者，这些患者存在单纯或主要的左心室功能障碍。在有活动能力的晚期 HF 患者中，生存获益不太明确。时机至关重要：过早、不必要地暴露于手术风险和器械相关并发症（感染、中风和出血），应权衡因推迟植入而死亡或发生不可逆转的右心室和/或终末器官功能障碍的可能性。LVAD 和心脏移植之间的相互作用在很大程度上取决于供体的可用性和分配规则。术后，生活质量取决于患者的期望，并受并发症的影响。在手术前和手术后，应公开讨论和审查患者的偏好、预后和替代方案，包括姑息治疗。
