对患有病态充血性心力衰竭的患者使用双管管辅助设备:一个合理的策略
Hiroyuki Tsukui1, Jeffrey J Teuteberg, Srinivas Murali
1Division of Cardiothoracic Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Circulation
|September 15, 2005
概括
对于严重的充血性心力衰竭而言,双管辅助器件 (BiVAD) 的支持显示了可接受的生存率和改善的结果. 移植后的生存率为58%,门诊治疗现在可以实现,降低了发病率.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 移植 移植 移植 移植
背景情况:
- 由于历史死亡率和门诊管理的挑战,对患病性充血性心力衰竭 (MCHF) 的双管节辅助器件 (BiVAD) 的使用受到争论.
- 研究BiVAD在MCHF患者的疗效对于推进治疗选择至关重要.
研究的目的:
- 评估双心室辅助器件 (BiVAD) 植入患有病态充血性心力衰竭 (MCHF) 的患者的结果.
- 评估与BiVAD支持相关的生存率,移植成功率和发病率.
- 为了确定BiVAD上的MCHF患者门诊管理的可行性.
主要方法:
- 在1990年1月至2003年12月期间接受Thoratec BiVAD的73名患者的回顾性研究.
- 分析整体存活率,心脏移植率,设备断奶以及长期结果.
- 2000年之前和之后的疾病发病率 (感染,神经事件) 和再入院率的比较.
主要成果:
- 总体生存率为69% (42个移植,5个断奶,3个使用BiVAD). 除了特定的急性病例外,生存率提高到75%.
- 移植后的五年精算生存率为58%.
- 2000年以后,驱动线感染 (10%vs. 70%),血液感染 (54%vs. 79%) 和神经事件 (48%vs. 80%) 的显著减少.
- 2000年后,48%的患者得到了出院,38%的患者回家;45%的患者至少接受过一次再入院.
结论:
- 对MCHF的BiVAD支持提供了可接受的整体死亡率和移植后的存活率.
- 近年来,疾病发病率有显著改善.
- 用BiVAD对MCHF患者进行门诊治疗是可行的,并且越来越成功.
相关概念视频
Mitral Regurgitation III: Medical Management
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
Mitral Stenosis III: Medical Management
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
Heart Failure V: Medical Management
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Heart Failure VI: Adjunct Therapies
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Cardiomyopathy II: Dilated Cardiomyopathy
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
Cardiomyopathy V: Interprofessional Care
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...


