Carr Michael J, Smith Susan Ansley, Slaughter Mark S, Pahwa Siddharth
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY USA.
Indian J Thorac Cardiovasc Surg. 2023 Jul;39(Suppl 1):101-113. doi: 10.1007/s12055-023-01567-8. Epub 2023 Jul 20.
Since the time of their invention, implantable continuous flow left ventricular assist devices (LVADs) have improved the quality of life and extended survival for patients with advanced heart failure. The decision surgeons and their physician colleagues make with these patients to undergo implantation must come with full understanding of the immediate, short-term, and long-term implications of such a life-changing procedure. The presence of pathology regarding the aortic, mitral, and tricuspid valves introduces particularly complex problems for the surgical treatment strategy. Concomitant valve repair or replacement increases cardiopulmonary bypass and cross clamp times, and could potentially lead to worse outcomes in the perioperative setting. Following perioperative recovery, valvular pathology may worsen or arise de novo given the often drastic immediate physiologic changes in blood flow, septal function, and, over time, ventricular remodeling. Over the past two decades, there has been vast improvement in the device manufacturing, surgical techniques, and medical management surrounding LVAD implantation. Yet, addressing concomitant valvular pathology remains a complex question with no perfect solutions. This review aims to briefly describe the evolution of approach to valvular pathology in the LVAD patient and offer our opinion and treatment rationale.
自植入式连续血流左心室辅助装置（LVAD）发明以来，已改善了晚期心力衰竭患者的生活质量并延长了其生存期。外科医生及其内科同事与这些患者做出的植入手术决定，必须充分了解这一改变生活的手术的即刻、短期和长期影响。主动脉瓣、二尖瓣和三尖瓣的病变给手术治疗策略带来了特别复杂的问题。同期进行瓣膜修复或置换会增加体外循环和主动脉阻断时间，并可能在围手术期导致更差的结果。围手术期恢复后，鉴于血流、室间隔功能以及随着时间推移心室重构方面常常发生的急剧即刻生理变化，瓣膜病变可能会恶化或新发。在过去二十年中，围绕LVAD植入的设备制造、手术技术和医疗管理有了巨大改进。然而，处理同期瓣膜病变仍然是一个复杂的问题，没有完美的解决方案。本综述旨在简要描述LVAD患者瓣膜病变治疗方法的演变，并提供我们的观点和治疗依据。
