心脏移植和人工心脏治疗终末期心力衰竭面临的问题与挑战

Problems and challenges of heart transplantation and artificial heart in the treatment of end-stage heart failure

心力衰竭发生率和死亡率很高,严重影响患者生活质量和寿命。同种心脏移植(以下简称心脏移植)是终末期心力衰竭有效的治疗方法,但仍然存在供心来源严重不足和利用不足、排斥反应、免疫抑制剂的毒性影响及移植心脏血管病严重并发症。近年来,人工心脏移植有了很大的进展,左心室辅助装置植入后2年生存率基本等同心脏移植,为终末期心力衰竭患者提供了另一种治疗选择;异种心脏移植(XTx)研究及临床应用也获得了重要突破,2022年1月完成了首例转基因猪-人XTx,存活2个月。XTx和人工心脏治疗终末期心力衰竭尽管有突破,但仍需进一步加强创新研究,以便获得更好的长期效果。本文就心脏移植和人工心脏治疗终末期心力衰竭面临的问题进行分析和探讨,期望该类患者最终能够得到更有效的治疗。

The incidence and mortality of heart failure are high,which seriously affects the quality of life and longevity of patients.Allogeneic heart transplantation(hereinafter referred to as heart transplantation)is an effective treatment for end-stage heart failure,but there are still some problems,including serious shortage and underutilization of donor hearts,rejection,toxic effects of immunosuppressants,and serious complications such as cardiac allograft vasculopathy.In recent years,artificial heart transplantation has made great progress.The 2-year survival rate after left ventricular assist device implantation is basically equivalent to that of heart transplantation,providing another treatment option for patients with end-stage heart failure.Furthermore,important breakthroughs have been made in the research and clinical application of cardiac xenotransplantation(XTx).The first transgenic porcine-to-human cardiac XTx was completed in January 2022 and the recipient survived for 2 months.Although heart transplantation and artificial heart have breakthrough in the treatment of end-stage heart failure,further innovative research is needed to achieve better long-term results.This paper analyzes and discusses the problems faced by heart transplantation and artificial heart in the treatment of end-stage heart failure,hoping that these patients can finally get more effective treatment.