文档介绍：CurrentStatusofVADApplicationforHeartFailureinChina心脏辅助装置(VAD)-HeartGroup2014InternationalHeartFailureConferencinChangsha心衰自然史NaturalHistoryofHeartFailureJessup,NEJM2003;348:2007USA:Total5,000,000CHF,,000newcases/,000,,000died/:Ischemic: 70%ardiomyopathy: 13%Hypertension: 7%…China:>4,500,000CHF500,000newcases/:Coronary: 46%Rhumatic: 18%Hypertension,Cardiomyopathy,Congenital,…-45%,重症患者多见心衰治疗方法CHFTherapyPhysicalRehabilitation-体能康复治疗MedicalTherapy-药物治疗SurgicalTherapy--"End-stageHeartDis."-外科治疗--最具挑战和最后的战场Social&-bined,individualizedTherapy-特异、综合、个体化的系统治疗方案Correctthecause(indexevent):治疗原发病变 -Coronaryarterydisease-CABG -Structuralvalvedisease-Valvereplacement/repairCorrecttheconsequencesofLVremodelling(secondarydamage) 纠正继发病变 -LVrestaurationReplace 置换/替代 -Transplantation -Heartassistdevices治疗原则PrincipalofTherapyClassificationofISHLTLevel-1:crashandburn -灾难急救期Level-2:slidingonIVinotropes -静脉正性肌力药仍恶化Level-3:dependantstabilitystableoninotropes -靠正性肌力药稳定Level-4:frequentflyer -反复发作住院Level-5:housebound -在家里活动Level-6:walkingwounded -可外出活动VADVADHistory:>40YearsGoalsofVADBridgeToRecovery(BTC)恢复的桥梁BridgeToTransplantation(BTT)移植的桥梁DestinationTherapy(DT)终期永久植入AsanalternativetotransplantationBridgeToDecision(BTD)决策的桥梁应用于二种完全不同的情况:StrategyofVADCardiogenicShock心源性休克-lifesavingprocedure -救命-usingextracorporealdevices -体外装置-topermitsurvivaluntiltransplantatonorrecovery -等待移植或恢复AdvancedCardiacFailure进行性心衰-instablepatients -稳定的择期病人--永久可植入性装置,不移植心源性休克病人急救和辅助的目的restoreimmediatlyhemodynamicsandmetabolism-立即重建血流动力学和新陈代谢savethebrain -挽救大脑、肾脏等重要脏器givetimetoevaluateareasonablestrategy:recovery,transplantationorlasttherapy -有时间制定合理的战略:恢复、移植、永久植入withanfriendlyuserandrapidtechnique,whichreallygivestime -有熟练团队、快速技术,争取到有价值的时间辅助目标TargetofSupport