Mechanical Circulatory Support Registering a Therapy in Evolution
Mechanical Circulatory Support Registering a Therapy in Evolution
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DOI：
10.1161/circheartfailure.108.782599
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发表时间：
2008-09-01
影响因子：
9.7
通讯作者：
Naftel, David C.
中科院分区：
文献类型：
--
作者：
Kirklin, James K.;Naftel, David C.
耐久性机械循环支持系统的发展促进了心脏移植的发展。美国国立卫生研究院在20世纪80年代资助开发植入式左心辅助系统; 20年后，他们签约建立了一个国家登记处，即机械辅助循环支持机构间登记处，以跟踪这项新技术的临床演变。机械辅助循环支持跨机构登记研究完善了纽约心脏协会IV级心力衰竭的分类，标准化了不良事件定义，并探索了器械类型、位置和策略的结局。大多数机械循环支持患者的年龄在50至70岁之间，90%的患者在植入前处于最高水平的临床不稳定状态。装置植入后6个月的存活率为75%，但在植入时未休克的患者中，存活率提高到80%。需要双心室支持的患者生存率降低。随着长期结果的分析，改善的结果可能证明了等待心脏移植的高风险患者的分类为慢性机械循环支持。
The development of durable mechanical circulatory sup-port systems paralleled the expansion of cardiac transplantation. The National Institutes of Health sponsored grants in the 1980s to develop implantable left heart assist systems; 20 years later, they contracted for a national registry, the Interagency Registry for Mechanical Assisted Circulatory Support, to track the clinical evolution of this new technology. The Interagency Registry for Mechanical Assisted Circulatory Support has refined the classification of New York Heart Association class IV heart failure, standardized adverse event definitions, and explored outcomes of device type, location, and strategy. The majority of mechanical circulatory support patients are between the ages of 50 and 70 years, and 90% of patients are in the highest levels of clinical instability before implantation. Six-month survival after device implant is 75%, but it increases to 80% among those not in shock at implantation. Patients who require biventricular support have decreased survival. As longer-term outcomes are analyzed, improved outcomes may justify triage of high-risk patients awaiting heart transplantation to chronic mechanical circulatory support.