机械循环支持治疗心力衰竭的研究进展

Mechanical Circulatory Support for Heart Failure

目前终末期心力衰竭的治疗除药物和心脏移植外,主要依赖机械循环支持,后者自20世纪末出现以来,已取得了长足进步,应用领域从最初的心脏移植前过渡逐渐扩展到心力衰竭的长期支持乃至终点治疗。最新的机械循环支持以左心室辅助装置为主,包括主动脉内球囊反搏泵、体外膜肺及全人工心脏等。近年来,随着制造工艺和材料的革新,机械循环支持的适应证逐渐拓展,机械辅助治疗充血性心力衰竭的随机化评估、HeartMateⅡ终点治疗等大规模临床试验也验证了其在不同心力衰竭患者中的获益。随着应用例数的增加,临床证据日臻完善,但也逐渐浮现出诸如出血、感染、血栓、机械故障等并发症。这些问题的出现,对装置的植入时机、手术技术、术后维护提出了更高的要求。目前,机械循环支持系统的小型化、驱动系统的零接触化及新型生物材料的使用,推动了新一代设备的革新,使其向着便携式、简单化、持久耐用的方向发展,有望在未来完全替代心脏移植,成为心力衰竭的标准化治疗方案。

The current therapy for end stage heart failure mainly consists of standard medication,cardiac transplantation and mechanical circulatory support （MCS）. Ever since its＇ invention in the 20th century, considerable progress have been seen in this field. With the progress of technology, the utilization of mechanical circulatory support has evolved from solo pre-transplantation bridging into long term and destination support. The most extensively used and studied MCS apparatus is the left ventricular assist device （VAD or LVAD）, accompa- nied by intra aortic balloon pump, extracorporeal membrane oxygenation and total artificial heart. According to the latest evidence from re- cent large scale clinical trials such as REMATCH, HM Ⅱ DT, etc, indications for MCS has expanded and patients treated with this technol- ogy received substantial benefits. A growing number of MCS supported patients have added new evidence into our current knowledge, inclu- ding emerging cases with various complications, such as bleeding, infection and thrombosis. All these changes are calling for optimization of implantation timing, operation techniques and peri-procedure care. The recent progress of minimized component, contact-free rotor driving system, as well as the evolution of novel material, is facilitating the development of next-generation MCS, featured by optimized mobility, simplicity and durability. Hopefully, future cardiac mechanical support device will replace cardiac transplantation and become a standard treatment for heart failure.