摘要
左心室辅助装置(left ventricular assist devices,LVAD)作为终末期心力衰竭患者的重要治疗手段,显著改善了患者的生存率和生活质量。然而,LVAD植入对右心功能产生了复杂而深远的影响,右心功能不全已成为影响LVAD患者预后的关键因素。本文系统综述了LVAD与右心功能的关系,探讨了右心功能在LVAD患者中的重要性、评估方法、影响机制以及预防和管理策略。综合现有证据表明,术前右心功能的全面评估对预测右心功能不全风险至关重要,而有效的预防和管理则依赖于术前优化、精细的术中操作、严密的术后监测以及多学科协作。此外,本文还探讨了改良型LVAD设计、双心室辅助、基因治疗及个体化医疗等新兴技术在改善右心功能不全方面的潜力与未来方向。总之,右心功能是LVAD治疗成功的关键决定因素之一,通过全面评估、预防和管理右心功能,以及新技术的应用,有望进一步改善LVAD患者的临床结局。
Left ventricular assist device(LVAD)serves as a critical therapeutic option for patients with end-stage heart failure,significantly enhancing survival rates and quality of life.However,LVAD implantation exerts complex and profound effects on right ventricular(RV)function,with RV dysfunction emerging as a key factor influencing the prognosis of LVAD patients.This article systematically reviews the relationship between LVAD and RV function,exploring the importance of RV function in LVAD patients,assessment methods,underlying mechanisms of impact,and strategies for prevention and management.Comprehensive evidence suggests that preoperative evaluation of RV function is crucial for predicting the risk of RV dysfunction,while effective prevention and management rely on preoperative optimization,meticulous intraoperative techniques,rigorous postoperative monitoring,and multidisciplinary collaboration.Furthermore,this review discusses the potential and future directions of emerging technologies,such as improved LVAD designs,biventricular assist devices,gene therapy,and personalized medicine,in ameliorating RV dysfunction.In conclusion,RV function is one of the key determinants of successful LVAD therapy.Through comprehensive assessment,prevention,and management of RV function,coupled with the application of novel technologies,the clinical outcomes of LVAD patients can be further improved.
作者
李坤生
王宇朦
密琳
季文杰
程永庆
徐贞俊
王东进
潘俊
LI Kunsheng;WANG Yumeng;MI Lin;JI Wenjie;CHENG Yongqing;XU Zhenjun;WANG Dongjin;PAN Jun(Department of Cardiac Surgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,210008,P.R.China;Gulou Clinical College of Nanjing Medical University,Nanjing,210008,P.R.China;Gulou Clinical College,Nanjing University of Chinese Medicine,Nanjing,210008,P.R.China)
出处
《中国胸心血管外科临床杂志》
北大核心
2025年第11期1655-1663,共9页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
中华国际医学交流基金会第五届心血管多学科整合思维研究基金(2022-N-01-04)
教育部产学合作协同育人项目(240906521154358)
南京中医药大学医学院·整合医学学院本科教育教学改革研究课题(NZYYXY2023009)
南京鼓楼医院临床研究专项资金项目(2021-LCYJ-PY-31)。
关键词
左心室辅助
心力衰竭
作用机制
综述
Left ventricular assist
heart failure
mechanism of action
review
