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1、心脏移植和机械型循环辅助（英心脏移植和机械型循环辅助（英文）文）MetabolicStressTestingMancini D et al.Circulation 1991;83:778-786.Group1:peakVO214Group3:rejectedforOHTxDescriptionofUNOSStatusLevelsStatusIAStatusIARHCinplaceand:twoormoreinotropesregardlessofdoseIVmilrinoneatleast0.5mcg/kg/minIVdobutamineatleast7.5mcg/kg/min30daysfo
2、llowingmedicalstabilizationafterVADimplantationStatusIBStatusIBinotrope-dependentLVADnotmeetingcriteriaforIAstatusNoadvantageforbeinghospitalizedStatusIIStatusIINotinotrope-dependentandnoVADPriorityonUNOSlistbasedonstatuslevelanddurationoftimeinthatstatuslevelNocreditgivenfortimeatalowerstatuslevelS
3、tevensonLWetal.Circulation2003;108:492-7.InotropicTherapyforEnd-StageHeartFailureUniversityofMinnesotaVADImplantsHeartMateIIPulsatilevsContinuousFlowLVADsPulsatile/Volume DisplacementContinuous/RotaryHeartMateIIasBTTMillerL,BoyleA,etal.NEJM2007;357:893.HeartMateIIBTTClinicalTrialAdverseEventRatesAdv
4、erseEventHMII(62ptyrs)(n=133)HMVE1(86ptyrs)(n=280)%reductionBleedingrequiringsurgery0.781.4747Percutaneousleadinfection0.373.4989Stroke0.190.4457Non-strokeneurological0.260.6761RVfailurerequiringRVAD0.080.3073Events/Patient Year1Frazier OH,et al.J Thor CV Surg 2001MillerL,JohnR,BoyleA,etal.NEJM2007;
5、357:893.HMIIasBTTinWomenOutcomesatoneyearPamboukianS,BoyleA,etal.Circulation.2008;118:S-1016VentrAssistasBridgetoTransplantVentrAssistComponentsImplantablebloodpumpPoweredviapercutaneousleadControllerlogsparameters&alarmsBatteryorACpowersupplyLaptopPCforclinicianuseBloodpumpOutflowcannulaControllera
6、ndbatteryreceptaclePercutaneousleadInflowcannulaSummaryTotalnumberofpatientsimplanted421Longestsupportduration(d)1594Meansupportduration(d)219Numberofpatientscurrentlysupported180VentrAssistSupportDuration6months19212months6724months16WorldwideVentrAssistExperience*Asof3/3/09StudyOutcomes:InterimAna
7、lysisPopulation(n=98)StudyOutcomes:InterimAnalysisPopulation(n=98)BoyleAetal.ACCLateBreakingClinicalTrial2009.NewestVAD:HeartwareVADsvsCRTforNYHAClassIVHeartFailure2YearMortalitywithCRT/CRT-DinNYHAClassIVPatientsLindenfeldJetal.Circulation2007;115:204-212.COMPANIONNYHAClassIVPatientsLindenfeldJetal.
8、Circulation2007;115:204-212.ImprovementinMedianDistanceWalkedinSixMinutes:HeartMateIIvsCRT/CRT-DBoyleAetal.PresentedatACC2008.ConclusionsTesttodeterminecandidacyfortransplantismetabolicstresstestMediansurvivalpost-transplantis10yearsFrequencyoftransplantationisdecliningLongterminotropictherapynotverysuccessfulContinuousflowVADsshowgoodlongtermsurvivalwithreducedadverseeventsVADsnowapprovedforBSAaslowas1.2CRTforNYHAClassIVheartfailurenotterriblyeffective结束语结束语谢谢大家聆听！谢谢大家聆听！27