The current state of left ventricular assist devices: challenges facing further development

Heart failure is a clinical syndrome with significant morbidity and mortality. The use of left ventricular assist devices has improved outcomes for patients with advanced heart failure in the face of limited donor organs available for heart transplantation. This article describes current issues and limitations facing the left ventricular assist device field and explores how the field can be expanded in this setting.     

终末期心衰病人院外左心辅助Incor I治疗

目的评价终末期左心功能衰竭(ESHF)病人院外使用新型左心室辅助装置(LVAD)Incor I轴流泵辅助治疗的可行性。方法2002年6月~2004年1月对23例ESHF病人植入Incor I轴流泵辅助治疗。结果至2004年9月累计辅助治疗8 126d,平均辅助时间(353±44)d。2例(8.70%)在心功能恢复后成功撤离LVAD,11例(47.83%)接受心脏移植手术。现有辅助病例8例(34.78%),最长辅助治疗天数835d。死亡2例(8.70%)。结论Incor I辅助泵治疗的ESHF病人可出院等待心脏移植供体或心脏功能恢复,Incor I辅助泵也可作为永久辅助装置应用于不适合心脏移植的病人。     

Heart transplantation without informed consent: discussion of a case

Objective: To discuss informed consent to heart transplantation in the case of an intensive care unit (ICU) patient: relatives' informed consent was refused by the patient himself whose cognitive ability appeared to be reasonable for the purpose. Setting: ICU of a university teaching hospital. Patient: a 62-year-old man who underwent myocardial revascularization had in the immediate post-operative hemodynamic instability, continuous serious arrhythmias, ventilatory support, fentanyl infusion. Heart transplantation could be the only chance for his survival. Intervention: heart transplantation. Results: despite patient's refusal, we decided to hold the relative's consent as valid, and transplantation was accordingly performed, to the subsequent satisfaction of the patient. Conclusions: Our decision was based on two beliefs: (1) the severity of the patient's clinical condition may have impaired his cognitive abilities; (2) the very same conditions may mask impairment and certainly make reliable assessment of cognition and judgment impossible. This being so, the preservation of life assumes priority. Received: 18 February 1997 Accepted: 18 December 1997     

冠心病患者心率变异性与室性心律失常的关系

目的　探讨冠心病患者心律变异性 (HRV )与室性心率失常之间的关系。方法　对 88例冠心病患者 ,根据动态心电图上室性早搏 (室早 )频次分为冠心病频发室早组 ( 4 2例 )和冠心病无室早组 ( 4 6例 )进行比较 ,并分别与正常对照组( 3 0例 )进行比较 ,观察HRV的时域指标和室性心律失常。结果　冠心病患者HRV时域指标SDNN、SDANN、SDNNin dex、rMSSD和PNN50 均明显低于正常对照组 (P <0 .0 5～ 0 .0 1) ,而冠心病频发室早组除rMSSD外 ,余各项指标也明显低于冠心病无室早组 (P <0 .0 5～ 0 .0 1) ;SDNN与冠心病室性早搏频次存在明显的相关性。结论　冠心病患者HRV减低 ,反映了冠心病患者心脏自主神经调节功能失衡 ,尤其在伴有频发室早的患者中更为明显 ;冠心病室早的发生与交感神经活性增强有关 ,通过长时HRV分析 ,能对此作出客观评价     

Heart transplantation in pediatric cardiomyopathies

Cardiomyopathies represent an uncommon but serious cause of heart disease in the pediatric population and can be categorized as dilated, hypertrophic, restrictive and left ventricular non-compaction. Each of these subtypes has multiple potential genetic etiologies in addition to possible non-genetic causes. Many patients with cardiomyopathies can benefit from transplantation, although there is not insignificant morbidity and mortality for those patients. Outcomes both prior to and following transplantation depend on the underlying etiology, the amount of support needed prior to transplantation and the illness severity of the patient prior to transplantation. Mechanical circulatory support is frequently used to bridge patients to transplantation, and newer technologies are currently in development.     

Cardiac rehabilitation in a heart failure patient after left ventricular assist device insertion and subsequent heart transplantation: A case report

BACKGROUNDInsertion of a left ventricular assist device (LVAD) and heart transplantation (HT) improve the survival of patients with heart failure. In addition, cardiac rehabilitation (CR) further increases the functional capacity. This case report describes a successful case of CR after LVAD insertion and subsequent HT.CASE SUMMARYIn the present case, during the LVAD insertion period, peak oxygen consumption (VO₂) increased by 12.16% after CR. HT was performed 7 mo after the LVAD insertion, and the patient participated in phases I and II CR. The peak VO₂ increased from 17.24 to 22.29 mL/kg/min. This improvement was more significant than that reported in previous studies on CR after LVAD insertion or HT. The patient’s quality of life also improved. The total average score of the short form-36 questionnaire increased from 29.5 points at admission to 53.3 points 9 mo after HT.CONCLUSIONA tailored CR program after LVAD insertion or HT may improve the patients’ quality of life and increase survival.     

同种异体原位心脏移植术后患者的心理特征分析及护理对策

目的：分析行同种异体原位心脏移植术治疗的患者术后心理特征及护理对策,评价实施针对性护理措施的效果。方法选择初次在本院进行同种异体原位心脏移植术的34例患者为研究组,另选择在本院门诊检查的84例健康人群为对照组,采用 SAS 量表、SDS 量表、SCL-90量表和社会支持量表评估患者的心理状态,研究组与对照组比较分析患者的心理特征,研究组护理干预前后比较评价针对性护理的效果。结果研究组患者 SAS 总标准分、SDS 标准分和 SCL-90总均分显著高于对照组,社会支持量表评分显著低于对照组,组间比较差异有统计学意义(t=14.796、4.531、9.522和-10.914,P<0.01);研究组护理干预后 SAS 总标准分、SDS 标准分和 SCL-90总均分显著降低,社会支持总体评分显著提高,护理干预前后比较差异有统计学意义(t =14.352、15.727、12.945、5.143,P<0.01)。结论同种异体原位心脏移植术治疗的终末期心脏病患者术后普遍存在躯体化、抑郁、焦虑、敌对、恐怖等不良心理状态,采取对症护理干预措施可显著改善患者的心理状态。     

同种原位心脏移植26例

目的：总结26例终末期心脏病患者施行原位心脏移植术的经验。方法：2001年1月26日至2003年9月26日，先后对26例终末期心脏病患者施行原住心脏移植术。供者均为脑死亡者，供心保护采用灌注冷晶体心脏停搏液，术式为标准原位心脏移植术，术后采用新三联他克莫司(FK506)骁悉扣泼尼松免疫抑制治疗。结果：6例死亡，20例患者存活至今，生活质量良好。结论：选择合适供、受体，加强囤术期处理及合理免疫抑制治疗是提高心脏移植术后疗效的重要因素。     

Current status of mechanical circulatory support for treatment of advanced end-stage heart failure: successes,shortcomings and needs

Introduction: Heart failure (HF) remains a major global burden in terms of morbidity and mortality. Despite advances in pharmacological and resynchronization device therapy, many patients worsen to end-stage HF. Although the gold-standard treatment for such patients is heart transplantation, there will always be a shortage of donor hearts.

Areas covered: A left ventricular assist device (LVAD) is a valuable option for these patients as a bridge measure (to recovery, to candidacy for transplant, or to transplant itself) or as destination therapy. This review describes the current indications for and complications of the most commonly implanted LVADs. In addition, we review the potential and promising new LVADs, including the HeartMate 3, MVAD, and other LVADs. Studies investigating each were identified through a combination of online database and direct extraction of studies cited in previously identified articles.

Expert commentary: The goal of LVADs has been to fill the gap between patients with end-stage HF who would likely not benefit from heart transplantation and those who could benefit from a donor heart. As of now, the use of LVADs has been limited to patients with end-stage HF, but next-generation LVAD therapy may improve both survival and quality of life in less sick patients.     

辅助肾小管装置免疫调节机理研究

目的研究辅助肾小管装置参与全身免疫调节的机理.方法分别用感染患者持续血液滤过(continuous venovenous hemofiltration,CVVH)超滤液和脂多糖(LPS)干预培养人肾小管上皮细胞系HKC细胞,用RT-PCR、ELISA检测IL-10转录水平和蛋白水平表达变化,用"transwell"方法检测IL-10在HKC细胞内的转位特点.结果RT-PCR、ELISA结果显示,HKC细胞暴露于感染患者CVVH超滤液或含LPS培养液后,IL-10转录水平升高,上清中IL-10蛋白水平升高."transwell"方法检测发现IL-10向两侧分泌.结论辅助肾小管装置中的HKC可以通过表达IL-10,参与全身免疫调节.     

Impella临床应用现状及进展

Impella是一种心室辅助装置,可以减轻左心室负荷,增加冠脉血流量,减少心肌耗氧,改善循环衰竭,过去常用于心源性休克及高危经皮冠状动脉介入治疗,现在心肌炎、心肌病、心力衰竭中亦有使用。Impella因其轴流泵快速运转和较大的导管直径,会引起诸多并发症,随着设备完善、研究深入,对Impella并发症的防治措施提供了一些新的思路。本文对Impella于心血管领域中的应用现状及进展做一综述。     

Ventricular assist device in the emergency department: Evaluation and management considerations

Ventricular assist devices (VAD) are being used at increasing rates in patients with severe, end-stage heart failure. Specific indications include VAD placement as a bridge to cardiac function recovery, a bridge to cardiac transplantation, or destination therapy (long-term support for patients ineligible for transplant). The assessment and management of the VAD patient is rather complex, requiring a basic knowledge of device structure and function. This article reviews the basic structure and function, discusses the approach to the VAD patient in the ED, and reviews the more common presentations and complications encountered in these technology-complex patients who are critically ill at baseline.     

慢性充血性心力衰竭患者的心率变异性分析

目的：评价心率变异性在慢性充血性心力衰竭患者中的变化。方法：用24h动态心电图研究慢性充血性心力衰竭患者与对照组的心率变异性及比较其他心脏结构及功能参数。结果：慢性充血性心力衰竭组的SDNN，SDANN，LF，HF，LF／HF均较对照组显著降低（P＜0．05），且随心衰严重程度增加，心率变异性呈递减，并与LVEF，LVEDD及LVSF改变相关（P＜0．05或P＜0．01）。结论：心率变异性可作为了解心衰程度、指导治疗和判定预后的参考指标之一。     

超声心动图对心脏移植术后右心形态学改变的观察及其机制分析

目的：观察心脏移植术后右心形态改变，并对其机制进行分析。方法：研究对象共分为3组；心脏移植组(A组)、肝脏移植组(B组)及正常对照组(C组)，A、B两组按术后激素用量大小分为第一及第二阶段，测量不同阶段右室舒张末期内径(RVEDD)、右室舒张末期容积(RVEDV)等指标观察右心形态及功能变化，同时观察三尖瓣返流情况并推测肺动脉压，将结果与正常组相比较，并进行统计学分析。持续观察1年。结果：A组患者第一阶段右心明显扩大，与正常组对照差别有显著性，右心扩大程度与手术后激素用量及补液量有关，B组患者术后第一阶段右心轻微增大，与正常组对照差别无显著性，第二阶段右心未见扩大。A组患者手术后三尖瓣返流持续存在，与肺动脉压无关。结论：心脏移植术后右心明显扩大，与右心容量负荷增加导致的钠水潴留有关，钠水潴留可能与心脏的去神经作用导致异常的心肾反射有关。     

Improving outcomes in peripartum cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare condition with a diverse spectrum of potential outcomes, ranging from frequent complete recovery to fulminant heart failure and death. The pathogenesis of PPCM is not well understood, and relatively little is known about its incidence and prevalence. PPCM is often under-recognised in the clinical setting. Early investigation and diagnosis with subsequent expert management may improve outcomes. The development of registries will allow this condition to be better characterised and may help answer crucial questions regarding its optimal medical and surgical management. This paper reviews the potential approaches to improve outcomes in patients with PPCM.