心室辅助装置的发展历程与未来展望The evolution of ventricular assist devices and future perspectives
李盛华,柳梅,李涵泺,雷雅岚,尚小珂
摘要(Abstract):
心室辅助装置(VAD)作为治疗终末期心力衰竭的重要手段,经历了从气动搏动式血泵到连续流离心泵的技术革新。本文详细介绍了HeartMateⅢ、EVAHEART 2、Heart Con等多款VAD的产品信息,第一代VAD虽并发症频发,但为后续发展奠定了基础;第二代VAD显著改善了患者预后,但仍存在心室塌陷的风险;第三代VAD体积小,采用无接触悬浮技术显著提升了耐用性和血液相容性。未来VAD将更好地致力于模拟天然心脏的生理功能,通过增强搏动性、延长设备寿命等措施,为心力衰竭患者提供更多的治疗选择。
关键词(KeyWords): 心室辅助装置;心力衰竭;人工心脏;HeartMate Ⅲ;EVAHEART 2;Heart Con
基金项目(Foundation): 国家重点研发计划项目(2023YFC2706203);; 武汉市科技局科技成果转化重点项目(2024030803010189);; 武汉市东湖高新“揭榜挂帅”项目(2024KJB345)
作者(Author): 李盛华,柳梅,李涵泺,雷雅岚,尚小珂
参考文献(References):
- [1]张长东,尚小珂,董念国.心力衰竭结构性介入治疗进展迅速,未来可期[J].中国介入心脏病学杂志,2024,32(8):421-424.DOI:10.3969/j.issn.1004-8812,2024.08.001.
- [2]Capriotti T,Micari M.Chronic heart failure treatment with the left ventricular assist device[J].Home Healthc Now,2019,37(4):190-197.DOI:10.1097/nhh.0000000000000777.
- [3]Raj L,Adhyaru B.An evidence-based review of recent advances in therapy for heart failure with reduced ejection fraction(HFrEF)[J].Postgrad Med J,2016,92(1094):726-734.DOI:10.1136/postgradmedj-2016-134378.
- [4]Hao G,Wang X,Chen Z,et al.Prevalence of heart failure and left ventricular dysfunction in China:the China Hypertension Survey,2012-2015[J].Eur J Heart Fail,2019,21(11):1329-1337.DOI:10.1002/ejhf.1629.
- [5]刘明波,何新叶,杨晓红,等.《中国心血管健康与疾病报告2023》概要(心血管疾病流行及介入诊疗状况)[J].中国介入心脏病学杂志,2024,32(10):541-550.DOI:10.3969/j.issn.1004-8812.2024.10.001.
- [6] Yancy CW,Jessup M,Bozkurt B,et al.2013 ACCF/AHA guideline for the management of heart failure:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].J Am Coll Cardiol,2013,62(16):e147-e239.DOI:10.1016/j.jacc.2013.05.019.
- [7]陈天怡,苏晞,徐承义.双心室辅助装置治疗巨细胞心肌炎1例[J].中国介入心脏病学杂志,2023,31(9):702-705.DOI:10.3969/j.issn.1004-8812.2023.09.011.
- [8]Redfield MM.Heart failure--an epidemic of uncertain proportions[J].N Engl J Med,2002,347(18):1442-1444.DOI:10.1056/NEJMe020115.
- [9]Hunt SA.Taking heart--cardiac transplantation past,present,and future[J].N Engl J Med,2006,355(3):231-235.DOI:10.1056/NEJMp068048.
- [10]Cheng H,Zhong W,Wang L,et al.Effects of shear stress on vascular endothelial functions in atherosclerosis and potential therapeutic approaches[J].Biomed Pharmacother,2023,158:114198.DOI:10.1016/j.biopha.2022.114198.
- [11]DeBakey ME.Left ventricular bypass pump for cardiac assistance.Clinical experience[J].Am J Cardiol,1971,27(1):3-11.DOI:10.1016/0002-9149(71)90076-2.
- [12] Cooley DA,Liotta D,Hallman GL,et al.Orthotopic cardiac prosthesis for two-staged cardiac replacement[J].Am J Cardiol,1969,24(5):723-730.DOI:10.1016/0002-9149(69)90460-3.
- [13]DeVries WC,Anderson JL,Joyce LD,et al.Clinical use of the total artificial heart[J].N Engl J Med,1984,310(5):273-278.DOI:10.1056/nejm198402023100501.
- [14]Prinzing A,Herold U,Berkefeld A,et al.Left ventricular assist devices-current state and perspectives[J].J Thorac Dis,2016,8(8):E660-E666.DOI:10.21037/jtd.2016.07.13.
- [15]Rose EA,Gelijns AC,Moskowitz AJ,et al.Long-term use of a left ventricular assist device for end-stage heart failure[J].N Engl J Med,2001,345(20):1435-1443.DOI:10.1056/NEJMoa012175.
- [16]Matsumoto Y,Fujita T,Fukushima S,et al.Comparison of hemodynamic performance and clinical results with EVAHEART versus HeartMateⅡ[J].ASAIO J,2017,63(5):562-567.DOI:10.1097/mat.0000000000000530.
- [17]Moazami N,Fukamachi K,Kobayashi M,et al.Axial and centrifugal continuous-flow rotary pumps:a translation from pump mechanics to clinical practice[J].J Heart Lung Transplant,2013,32(1):1-11.DOI:10.1016/j.healun.2012.10.001.
- [18] Slaughter MS,Rogers JG,Milano CA,et al.Advanced heart failure treated with continuous-flow left ventricular assist device[J].N Engl J Med,2009,361(23):2241-2251.DOI:10.1056/NEJMoa0909938.
- [19]Starling RC,Moazami N,Silvestry SC,et al.Unexpected abrupt increase in left ventricular assist device thrombosis[J].N Engl J Med,2014,370(1):33-40.DOI:10.1056/NEJMoa1313385.
- [20]Moctezuma-Ramirez A,Mohammed H,Hughes A,et al.Recent developments in ventricular assist device therapy[J].Rev Cardiovasc Med,2025,26(1):25440.DOI:10.31083/RCM25440.
- [21]Myers TJ,Gregoric ID.Future of mechanical circulatory support:new systems on the horizon.In management of acute and chronic severe heart failure:advances in mechanical circulatory support[J].Springer,2025:493-513,DOI:10.1007/978-3-031-74963-6 29.
- [22]Ling LKF,Dong LR,Meiling W,et al.Recent updates on the treatment of heart failure:a review of the literature[J].RJLBPCS,2022,8(3):1-21.DOI:10.26479/2022.0803.01.
- [23]王伟,宋昱,张云强,等.HeartCon型左心室辅助装置治疗20例成人终末期心衰患者的近期效果观察[J].中华危重病急救医学,2022,34(12):1258-1262.DOI:10.3760/cma.j.cn121430-20220106-00015.
- [24]Kawamura A,Toda K,Sawa Y.First clinical experience with the double cuff tipless inflow cannula in the EVAHEART left ventricular assist system:case report[J].Artif Organs,2020,44(4):436-437.DOI:10.1111/aor.13588.
- [25]Fang P,Yang Y,Wei X,et al.Preclinical evaluation of the fluid dynamics and hemocompatibility of the Corheart 6 left ventricular assist device[J].Artif Organs,2023,47(6):951-960.DOI:10.1111/aor.14498.
- [26]Morshuis M,El-Banayosy A,Arusoglu L,et al.European experience of DuraHeart magnetically levitated centrifugal left ventricular assist system[J].Eur J Cardiothorac Surg,2009,35(6):1020-1027;discussion 1027-1028.DOI:10.1016/j.ejcts.2008.12.033.
- [27]Moazami N,Steffen RJ,Naka Y,et al.Lessons learned from the first fully magnetically levitated centrifugal LVAD trial in the United States:the DuraHeart trial[J].Ann Thorac Surg,2014,98(2):541-547.DOI:10.1016/j.athoracsur.2014.04.048.
- [28]Schmitto JD,Molitoris U,Haverich A,et al.Implantation of a centrifugal pump as a left ventricular assist device through a novel,minimized approach:upper hemisternotomy combined with anterolateral thoracotomy[J].J Thorac Cardiovasc Surg,2012,143(2):511-513.DOI:10.1016/j.jtcvs.2011.07.046.
- [29]Bourque K,Cotter C,Dague C,et al.Design rationale and preclinical evaluation of the HeartMate 3 left ventricular assist system for hemocompatibility[J].ASAIO J,2016,62(4):375-383.DOI:10.1097/mat.0000000000000388.
- [30]Javorski MJ,Zaki A,Abas M,et al.The current era of left ventricular assist devices[J].Future Cardiol,2021,17(6):971-984.DOI:10.2217/fca-2020-0177.
- [31]Tsiouris A,Slaughter MS,Jeyakumar AKC,et al.Left ventricular assist devices:yesterday,today,and tomorrow[J].J Artif Organs,2024,27(4):335-344.DOI:10.1007/s10047-024-01436-0.
- [32]Jefferson HL,Kent WDT,MacQueen KT,et al.L eft ventricular as sist devices:a comprehensive review of major clinical trials,devices,and future directions[J].J Card Surg,2021,36(4):1480-1491.DOI:10.1111/jocs.15341.
- [33]Stein A,Kovacevic M,Kyaw PA,et al.CARD14:wireless transcutaneous energy transfer and control system for powering a fully-implanted left-ventricular assist system[J].ASAIO Journal,2023,69(Supplement 2):64.DOI:10.1097/01.mat.0000943580.83459.85.
- [34]Botterbusch C,Barabino N,Cornat F,et al.Progress in the development of the pulsatile CorWave LVAD[J].J Heart Lung Transplant,2021,40(4):S104.DOI:10.1016/j.healun.2021.01.338.
- [35]Wang X,Zhou X,Chen H,et al.Long-term outcomes of a novel fully magnetically levitated ventricular assist device for the treatment of advanced heart failure in China[J].J Heart Lung Transplant,2024,43(11):1806-1815.DOI:10.1016/j.healun.2024.05.004.
- [36]刘晓程,王春生,周新民,等.国产HeartCon第三代磁液悬浮左心室辅助装置治疗50例终末期心力衰竭的前瞻性多中心临床试验研究[J].中华胸心血管外科杂志,2023,39(5):273-278.DOI:10.3760/cma.j.cnl12434-20220915-00297.
- [37]陈海波,王现强,杜娟,等.EVAHEARTⅠ全植入式心室辅助装置治疗心力衰竭长期疗效:附15例3年临床随访结果[J].中华心血管病杂志,2023,51(4):393-399.DOI:10.3760/cma.j.cn112148-20220614-00472.
- [38]邱志兵,宋晓春,李良鹏,等.国产磁悬浮左心室辅助装置治疗终末期心力衰竭患者的短中期有效性和安全性[J/OL].中国胸心血管外科临床杂志.(2025-01-21)[2025-2-15]https://link.cnki.net/urlid/51.1492.R.20250120.1748.024.