Left Ventricular Assist Devices Are Underutilized
Left Ventricular Assist Devices Are Underutilized
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DOI：
10.1161/circulationaha.110.958991
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发表时间：
2011-04-12
期刊：
影响因子：
37.8
通讯作者：
Miller, Leslie W.
中科院分区：
文献类型：
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作者：
Miller, Leslie W.
1552个月，2，16表明当患者达到HF的这个阶段时，有效的治疗选择很少。对于65岁的患者尤其如此，此时HF的患病率显著增加，并且移植，这可以说是最有效的治疗，基本上不再是一种选择，因为心脏供体的数量非常有限且相对固定（每年2200例）。17因此，VAD是唯一能显著改善生存率、生活质量和功能能力的选择，其结果等于或超过心脏移植的结果。不幸的是，这一选择没有得到充分利用。在机械循环支持领域最重要的问题之一是有多少患者将受益，并将是使用VAD的合理候选人，特别是作为心脏移植的替代方案，估计从40000到200000不等。候选人的估计值存在较大差异有几个原因，包括该领域的大多数数据都是基于具有限制性入选标准的临床试验、住院患者、对HF患者总数的跟踪不足以及分期和病情的变化。人群数量可能高估了准确的数量，因为包括了一些75岁的患者，他们可能有大量的合并症，不是很好的候选人;相反，在20岁时减少人数，排除了大量的儿科患者，他们的VAD数量越来越多。对于心力衰竭各阶段患者的百分比也存在很大争议，尤其是C期和D期。然而，有数据表明，A期和B期或无症状HF患者的死亡率增加。18 AHA心脏和卒中因素2估计的数据仍然基于以前的纽约心脏协会分类。这些估计表明，5%的HF患者处于最晚期IV级，10%至15%处于III级。这是一个完全主观的分类，并且经常会因观察者而异，并且当患者变得不稳定并需要住院治疗并且处于较高的分类中时，或者经历诸如心脏起搏治疗（CRT）或口服HF药物治疗的改善的程序时，改善他们的症状，并且因此降低他们的纽约心脏协会分类。
1552 months, 2, 16 indicating that when patients reach this stage of HF, there are very few effective treatment options. This is especially true for those 65 years of age, when the prevalence of HF increases significantly, and transplantation, which is arguably the most effective therapy, is essentially no longer an option because of the very limited and relatively fixed number of heart donors (2200 per year). 17 Thus, a VAD is the only other option that offers significant improvement in survival as well as quality of life and functional capacity, with results that equal or exceed those reported for heart transplantation. Unfortunately, this option is underutilized. One of the most important questions in the field of mechanical ciculatory support is how many patients would benefit and would be reasonable candidates for use of a VAD, especially as an alternative to heart transplantation, with estimates varying from 40000 to 200000. This wide variance in the estimates of candidates exists for several reasons, including the fact that most data in the field are based on clinical trials with restricted entry criteria, hospitalized patients, insufficient tracking of overall numbers of patients with HF, and the shifting of stage and condition. Population numbers may overestimate the accurate number by including some patients 75 years of age who may have a significant number of comorbidities and not be good candidates; conversely, cutting the number at 20 years of age eliminates a significant population of pediatric patients for whom an increasing number of VADs have become available. There is also significant controversy over the percentage of patients in each stage of HF, especially in stage C and D. However, there are data to show that the mortality of those with stage A and B, or asymptomatic HF, have increased mortality. 18 The data from the AHA Heart and Stroke Facts2 estimates are still based on the previous New York Heart Association classification. Those estimates suggest that 5% of HF patients are in the most advanced class IV, and 10% to 15% are in class III. This is a totally subjective classification and frequently can vary by observer, and as patients become unstable and require hospitalization and are in a higher class, or undergo procedures such as cardiac resynchronization therapy (CRT) or improvement in oral HF drug therapy, improve their symptoms, and thus lower their New York Heart Association class.