Reverse Remodeling With Left Ventricular Assist Devices.
Reverse Remodeling With Left Ventricular Assist Devices.
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DOI：
10.1161/circresaha.121.318160
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发表时间：
2021-05-14
影响因子：
20.1
通讯作者：
Uriel, Nir
中科院分区：
文献类型：
--
作者：
Burkhoff, Daniel;Topkara, Veli K.;Sayer, Gabriel;Uriel, Nir
这篇综述概述了过去25年以上对左心室辅助装置（LVAD）开发的研究，以改善严重终末期心力衰竭的患者的临床结局，并从接受LVAD支持的患者的心脏和心肌研究中获得的心力衰竭的基本见解获得了心力衰竭的生物学。审查了当代LVAD疗法的临床方面，包括不断发展的装置技术，整体死亡率和并发症。我们解释了LVAD支持的血液动力学作用以及这些如何导致心室卸载。这包括对LVAD相关反向重塑的结构，细胞和分子方面的详细回顾。 LVAD支持与医疗疗法之间有关与反向重塑，缓解和恢复有关的心力衰竭的医疗疗法之间的协同作用，在临床结果和对心肌生物学的基本影响的背景下进行了讨论。综述了最有可能与心室功能改善和心力衰竭减轻有关的发生率，临床意义和因素。最后，我们讨论了在绝大多数LVAD支持的心脏中实现心肌恢复的障碍，及其对未来研究的影响旨在提高总体恢复率。
This review provides a comprehensive overview of the past 25+ years of research into the development of left ventricular assist device (LVAD) to improve clinical outcomes in patients with severe end-stage heart failure and basic insights gained into the biology of heart failure gleaned from studies of hearts and myocardium of patients undergoing LVAD support. Clinical aspects of contemporary LVAD therapy, including evolving device technology, overall mortality, and complications are reviewed. We explain the hemodynamic effects of LVAD support and how these lead to ventricular unloading. This includes a detailed review of the structural, cellular and molecular aspects of LVAD-associated reverse remodeling. Synergisms between LVAD support and medical therapies for heart failure related to reverse remodeling, remission and recovery are discussed within the context of both clinical outcomes and fundamental effects on myocardial biology. The incidence, clinical implications and factors most likely to be associated with improved ventricular function and remission of the heart failure are reviewed. Finally, we discuss recognized impediments to achieving myocardial recovery in the vast majority of LVAD-supported hearts and their implications for future research aimed at improving the overall rates of recovery.