左心室辅助装置术后右心衰竭的诊断标准、病理生理特征、预测指标及治疗策略的研究进展

Advances on Diagnosis,Pathophysiological Characteristics,Predictor and Treatment Strategies of Right Heart Failure Post-Left Ventricular Assist Device Implantation

右心衰竭(rightheart failure,RHF)是左心室辅助装置(left ventricular assist device,LVAD)术后常见并发症之一,不仅影响围手术期血流动力学稳定,还增加术后死亡率。准确识别RHF的高危因素并制定最佳治疗方案对确保预后至关重要。但由于LVAD术后血流动力学变化的复杂性和RHF多因素的发生机制,RHF的预测及预防管理颇具挑战。目前,医疗对于LVAD术后RHF的治疗指南仍不明确,重症患者往往对药物治疗反应不佳,需要依赖右心机械辅助支持。本文综合现有文献资料,概述LVAD术后RHF的诊断标准、病理生理学特征、风险预测指标及治疗方案,旨在为优化LVAD术后RHF的治疗策略提供指导,并为改善患者的预后提供新的视角。

Right heart failure(RHF)is one of the frequent complications following left ventricular assist device(LVAD)surgery,adversely affecting perioperative hemodynamic stability and contributing to an increased risk of postoperative mortality.The identification of high-risk factors for RHF and the establishment of optimal treatment protocols are crucial for ensuring favorable outcomes.However,the complexity of post-LVAD hemodynamic alterations and the multifactorial mechanisms of RHF present significant challenges in prediction and preventive management.Currently,the clinical guidelines for the treatment of RHF after LVAD surgery are unclear,and critically ill patients often exhibit poor responses to pharmacological treatments,necessitating reliance on right heart mechanical support.This article synthesizes existing literature to comprehensively outline the diagnostic criteria,pathophysiological features,risk prediction indicators,and treatment strategies for RHF following LVAD surgery.It aims to guide the optimization of treatment strategies for RHF post-LVAD and offers new perspectives for improving patient outcomes.