4. 英国和欧洲心脏移植和LVAD植入的最新情况

Q2 Medicine
Steven Tsui
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引用次数: 0

摘要

虽然最近北美的心脏移植(HTx)出现了前所未有的增长,但在大多数欧洲国家,这一数字一直保持不变或下降。这导致了等待时间的显著增加。在英国,自2001年以来一直存在一项紧急心脏分配计划。随着越来越多的心力衰竭患者使用临时机械循环支持(MCS)设备,2016年引入了超级紧急类别。到目前为止,英国约15%的HTx是在这一新类别下进行的,中位等待时间约为7天。移植后30天的存活率令人放心。但是,需要不断进行监测以确保有效性。另一个主要发展是循环性死亡(DCD)后的捐赠。迄今为止,约100场DCD HTx已在全球演出,其中70场在英国。越来越多的等待名单导致越来越多的植入桥移植左心室辅助装置(LVAD)。然而,稳定患者等待供体心脏的时间延长意味着接受桥接的患者实际上默认接受目的地治疗。虽然目的地疗法在一些国家得到批准,但现有证据尚未被其他国家接受。瑞典评价LVAD作为终末期心力衰竭的永久性治疗(SweVAD)是一项前瞻性随机研究,比较LVAD治疗与最佳药物治疗。招募于2016年开始,目的是随机抽取74名患者。随着使用具有较低剪切应力的新型泵送机制的新设备的开发,以解决当前设备的固有局限性,与植入式MCS相关的结果和不良事件将进一步改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
4 Updates on cardiac transplant and LVAD implants across the UK and europe
Whilst there has recently been unprecedented growth in heart transplants (HTx) in North America, the number has been static or falling in most European countries. These have resulted in significant increases in the waiting times. In the UK, an Urgent Heart Allocation Scheme has been in existence since 2001. With a growing number of heart failure patients on temporary mechanical circulatory support (MCS) devices, a Super Urgent category was introduced in 2016. So far, ∼15% of HTx in the UK are performed under this new category and the median waiting time has been ≈7 days. Post-transplant 30 day survival has been reassuring. However, ongoing monitoring will be required to ensure effectiveness. The other major development has been donation after circulatory death (DCD) HTx. To date, ∼100 DCD HTx have been performed worldwide, with 70 of these being in the UK. Growing waiting lists have led to increased implantation of bridge-to-transplant left ventricular assist devices (LVAD). However, the extended waiting times for donor hearts in stable patients mean that patients being bridged are effectively having destination therapy by default. Whilst destination therapy is approved in some countries, the available evidence has not been accepted by other countries. The Swedish Evaluation of LVAD as Permanent Treatment in End-stage Heart Failure (SweVAD) is a prospective randomised study comparing LVAD therapy with optimal medical therapy. Recruitment commenced in 2016 with the aim of randomising 74 patients. Outcomes and adverse events associated with implantable MCS will further improve as new devices using novel pumping mechanisms with lower shear stress are in development to address inherent limitations of current devices.
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来源期刊
Heart Asia
Heart Asia Medicine-Cardiology and Cardiovascular Medicine
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