Melendo-Viu María, Dobarro David, Raposeiras Roubin Sergio, Llamas Pernas Carmen, Moliz Cordón Candela, Vazquez Lamas Miriam, Piñón Esteban Miguel, Varela Martínez Maria Ángela, Abu Assi Emad, Pita Romero Rafael, Legarra Calderón Juan José, Íñiguez Romo Andrés
Cardiology Department, University Hospital Álvaro Cunqueiro, 36213 Vigo, Spain.
Health Research Institute Galicia Sur, 36312 Vigo, Spain.
Life (Basel). 2023 Apr 21;13(4):1065. doi: 10.3390/life13041065.
Advanced heart failure is a growing problem for which the best treatment is cardiac transplantation. However, the shortage of donors' hearts made left ventricular assist devices as destination therapy (DT-LVAD) a highly recommended alternative: they improved mid-term prognosis as well as patients' quality of life. Current intracorporeal pumps with a centrifugal continuous flow evolved in the last few years. Since 2003, when first LVAD was approved for long-term support, smaller device sizes with better survival and hemocompatibility profile were reached. The most important difficulty lies in the moment of the implant. Recent indications range from INTERMACS class 2 to 4, with close monitoring in intermediate cases. Moreover, a large multiparametric study is needed for considering the candidacy: basal situation, with a special interest in frailty, comorbidities, including renal and hepatic dysfunction, and medical background, considering every prior cardiac condition, must be evaluated. In addition, some clinical risk scores can be helpful to measure the possibility of right heart failure or morbi-mortality. With this review, we sought to summarize all the device improvements, with their updated clinical results, as well as to focus on all the patient selection criteria.
晚期心力衰竭是一个日益严重的问题，其最佳治疗方法是心脏移植。然而，供体心脏的短缺使得左心室辅助装置作为终末期治疗（DT-LVAD）成为高度推荐的替代方案：它们改善了中期预后以及患者的生活质量。目前的离心式连续流体内泵在过去几年中得到了发展。自2003年首个LVAD被批准用于长期支持以来，已实现了更小的装置尺寸以及更好的生存和血液相容性。最重要的困难在于植入时机。近期的适应症范围从INTERMACS 2级到4级，对中间病例需密切监测。此外，需要进行一项大型多参数研究来考虑候选资格：必须评估基础状况，尤其关注虚弱、合并症（包括肾和肝功能障碍）以及病史，还要考虑既往的每一种心脏疾病。此外，一些临床风险评分有助于衡量右心衰竭或病死风险。通过本综述，我们试图总结所有装置的改进情况及其最新临床结果，并重点关注所有患者选择标准。
