左心室辅助装置治疗心力衰竭的现状及进展

Current status and progress of left ventricular assist device for end-stage heart failure

虽然心脏移植是治疗心力衰竭的最佳方案,但是有限的供体器官限制了心脏移植的应用。在过去的20多年里,左心室辅助装置在尺寸、耐用性和血液相容性方面取得了实质性进展,除了作为心脏移植的过渡治疗外,由于疗效显著,对于无法进行心脏移植的患者,左心室辅助装置也成为了他们的最终选择。虽然近年来左心室辅助装置的性能得到较大的改善,但在并发症的管理以及如何提高患者在装置植入后的生活质量方面依然存在着巨大挑战。本文将从以下几方面的现状及进展进行论述:(1)左心室辅助装置种类;(2)左心室辅助装置的手术指征;(3)左心室辅助装置的并发症;(4)左心室辅助装置植入后的管理。

Although heart transplantation remains to be the optimal treatment for advanced heart failure,its use has been largely limited due to shortage of available donor organs.Over the past two decades,left ventricular assist device(LVAD)has been significantly modified in size,durability and hemocompatibility.In addition to the bridge to transplantation,LVAD has become an attractive alternative to heart transplantation for end-stage heart failure as destination therapy for unsuitable candidates.Although the performance of LVAD has been improving greatly in recent years,there are still great challenges in the management of device complications and low quality of life after implantation.This review will summarize the types of LVAD,indications for implantation,postoperative management and adverse events.