Medical University of South Carolina, Charleston, South Carolina, USA.
CoreWell Health, Grand Rapids, Michigan, USA.
J Am Coll Cardiol. 2023 Oct 3;82(14):1464-1481. doi: 10.1016/j.jacc.2023.07.019.
Despite advances in medical therapy for patients with stage C heart failure (HF), survival for patients with advanced HF is <20% at 5 years. Durable left ventricular assist device (dLVAD) support is an important treatment option for patients with advanced HF. Innovations in dLVAD technology have reduced the risk of several adverse events, including pump thrombosis, stroke, and bleeding. Average patient survival is now similar to that of heart transplantation at 2 years, with 5-year dLVAD survival now approaching 60%. Unfortunately, greater adoption of dLVAD therapy has not been realized due to delayed referral of patients to advanced HF centers, insufficient clinician knowledge of contemporary dLVAD outcomes (including gains in quality of life), and deprioritization of patients with dLVAD support waiting for heart transplantation. Despite these challenges, novel devices are on the horizon of clinical investigation, offering smaller size, permitting less invasive surgical implantation, and eliminating the percutaneous lead for power supply.
尽管在治疗 C 期心力衰竭（HF）患者方面取得了进展，但晚期 HF 患者的 5 年生存率仍<20%。耐用型左心室辅助装置（dLVAD）支持是晚期 HF 患者的重要治疗选择。dLVAD 技术的创新降低了包括泵血栓形成、中风和出血在内的多种不良事件的风险。目前，患者的平均生存时间与心脏移植相似，2 年生存率为 60%，5 年 dLVAD 生存率接近 60%。不幸的是，由于将患者延迟转诊至晚期 HF 中心、临床医生对当代 dLVAD 结果（包括生活质量的提高）的了解不足，以及对等待心脏移植的 dLVAD 支持患者的重视程度降低，dLVAD 治疗的应用并未得到广泛推广。尽管存在这些挑战，但新型设备即将进入临床研究，具有更小的尺寸、允许更微创的手术植入，并消除了用于电源的经皮引线。
