Recovery of natural heart function in severe heart failure patients by long term circulatory support with ventricular assist system

应用体外国家心血管中心型左心室辅助系统（LVASs）对35例年龄小于60岁的心肌病患者进行心脏移植。其中扩张型心肌病30例，缺血性心肌病4例，肥厚型心肌病扩张期1例。尽管进行了大量的药物和/或手术治疗，但当患者病情恶化时，仍进行LVAS植入。35例患者中有5例因深度右心衰需要右心支持。在30例无右心支持的LVAS患者中，先植入左心引流型LVAS(LA) 10例。在最近的病例中，植入左心室引流型LVAS（LV）。LA型的平均辅助时间为165天，LV型的平均辅助时间为367天，包括正在进行的8例。应用LVAS后，所有病例均稳定。开始康复治疗，并给予受体阻滞剂和ACE抑制剂。定期用超声心动图检测自然心功能，待自然心功能恢复后再尝试脱离LVAS。LA型10例患者中有3例在支持3-5个月后自然心功能恢复，并拆除LVASs。3例患者在门诊切除后2.5 ~ 6.8年均恢复良好。20例LV型支架中，仅有4例心脏恢复正常。在一个病例中，由于自然心功能的急性恶化，切除了LVAS，然后重新植入了LVAS。7例（LA: 2例，LV: 5例）平均在330天的支持后进行心脏移植。他们切除的心脏显示心肌组织严重破坏。研究LA型与LV型在LVAS支持下对心功能的影响及自然心功能评价的差异。

Extracorporeal National Cardiovascular Center type left ventricular assist systems (LVASs) were applied to 35 cardiomyopathy patients who were considered to be candidates for heart transplantation aged younger than 60 years old. Of those, 30 patients were suffered from dilated cardiomyopathy, 4 from ischemic cardiomyopathy and 1 for dilated phase of hypertrophic cardiomyopathy. Implantation of LVAS was performed when patient condition was deteriorated in spite of massive medical and/or surgical treatments. Five of 35 patients were needed right heart support due to profound right heart failure. In 30 cases with LVAS support without right heart support, initial 10 cases were implanted left atrial drainage type LVAS(LA). In recent cases, left ventricular drainage type LVAS(LV) were implanted. Mean assist duration was 165 days in LA type and was 367 days, including ongoing 8 cases, in LV type. All cases were stabilized after application of LVAS. Rehabilitation was started and administrations of beta-blockers and ACE inhibitors were performed. Natural cardiac function was tested by echocardiography periodically and weaning from LVAS was tried when natural heart function showed recovery of its function. In LA type, 3 out of 10 cases showed recovery of their natural heart function and LVASs were removed after 3-5 months support. All three cases are doing well 2.5-6.8 years after removal under outpatient clinic. In 20 LV type supports, only 4 cases showed recovery of natural heart. In one case, removal from LVAS was performed followed by reimplantation of LVAS due to acute deterioration of natural heart function. In seven cases (LA: 2, LV: 5), heart transplantation was done after 330 days supports on average. Their excised hearts showed severe destruction of myocardial tissue. Difference between LA type and LV type in effects of cardiac function and evaluation of natural heart function under LVAS support were studied.