候选资格
移植的桥梁
医学
移植
心室辅助装置
目的地治疗
心脏移植
心力衰竭
回廊的
变向性
外科
重症监护医学
桥(图论)
心脏病学
内科学
政治
政治学
法学
作者
Jacinthe Boulet,Mauro R.B. Wanderley,Mandeep R. Mehra
出处
期刊:Transplantation
[Ovid Technologies (Wolters Kluwer)]
日期:2023-10-24
被引量:4
标识
DOI:10.1097/tp.0000000000004834
摘要
Left ventricular assist devices (LVADs), which were introduced as a bridge to heart transplantation, are now an established alternative to heart transplantation (HT) for patients with advanced heart failure. These devices have undergone significant technological advancements over the years, and contemporary LVADs prolong life substantially in patients dependent on inotropic therapy or in those with severe ambulatory advanced heart failure with a median survival that exceeds 5 y, and most patients benefit from a doubling in functional capacity, even among those intended as destination therapy because of ineligibility for transplantation. Other intended goals for LVAD implantation consist of (1) bridge to remission or recovery and (2) bridge to transplant or candidacy for transplant. In the former situation, few selected patients underwent LVAD implantation, facilitating myocardial remission to recovery that allowed explantation. Among those bridged to transplantation, survival in the intended goal was excellent, with 80% success at 5 y (with a 50% rate of transplantation). In this review, we provide a brief historical background on the evolution of LVADs and discuss outcomes with contemporary pumps, immunological and infection-related impact of such devices, impact of bridging in HT, and use of devices for facilitating myocardial recovery and remission. Furthermore, we discuss implications of HT allocation policies, with a specific focus within the United States, and outline future perspectives and novel device in development.
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