Department of Cardiac Surgery, La Pitié Sâlpétrière Charles Foix Hospital, Paris, France.
Department of Vascular and Cardio-Thoracic Surgery, Rennes University Hospital, Rennes, France.
Presse Med. 2024 Mar;53(1):104191. doi: 10.1016/j.lpm.2023.104191. Epub 2023 Oct 26.
In the last decades, outcomes significantly improved for both heart transplantation and LVAD. Heart transplantation remains the gold standard for the treatment of end stage heart failure and will remain for many years to come. The most relevant limitations are the lack of grafts and the effects of long-term immunosuppressive therapy that involve infectious, cancerous and metabolic complications despite advances in immunosuppression management. Mechanical circulatory support has an irreplaceable role in the treatment of end-staged heart failure, as bridge to transplant or as definitive implantation in non-transplant candidates. Although clinical results do not overcome those of HTx, improvement in the new generation of devices may help to reach the equipoise between the two therapies. This review will go through the evolution, current status and perspectives of both therapeutics.
在过去的几十年中，心脏移植和 LVAD 的治疗效果都有了显著的提高。心脏移植仍然是治疗终末期心力衰竭的金标准，并且在未来许多年内仍将如此。最相关的限制是缺乏移植物和长期免疫抑制治疗的影响，尽管免疫抑制管理取得了进展，但仍涉及感染、癌症和代谢并发症。机械循环支持在治疗终末期心力衰竭方面具有不可替代的作用，可以作为移植桥接或在非移植患者中作为确定性植入。尽管临床结果并未超过 HTx，但新一代设备的改进可能有助于在两种治疗方法之间达到平衡。本综述将探讨这两种治疗方法的演变、现状和展望。
