扩张型心肌病(DCM)是一种常见的以心室扩张和收缩功能障碍为特征的心肌疾病,导致严重的心力衰竭(HF),通常需要心脏移植(HTx)。本系统综述旨在综合有关心室辅助装置(VAD)在管理DCM引起的HF患者中的作用的信息。在PubMed进行了全面搜索,Embase,Scopus,WebofScience,和Cochrane数据库,用于2014年至2024年之间发表的研究。纳入标准是涉及因使用VAD治疗的DCM导致的成年HF患者的研究。排除标准包括非人类研究,儿科人群,和非同行评审的文章。31项研究符合纳入标准。纳入的研究表明,在DCM患者中使用VAD可以显着改善左心室射血分数(LVEF)。心肌纤维化减少,和逆转心室重构。研究报告生存率提高,症状减轻,和更好的生活质量。VAD是通往HTx的关键桥梁,在某些情况下,作为长期的目的地治疗。然而,并发症,如血栓形成,贫血,并注意到肾衰竭,强调需要警惕的监测和管理。发现VAD技术和患者管理协议的不断进步对于优化结果至关重要。我们得出的结论是,通过提供机械循环支持,VAD在管理DCM导致的高级HF中起着至关重要的作用,改善心脏功能,提高患者的生存和生活质量。尽管相关的并发症,VAD对于重度HF患者是无价的,提供即时和长期的治疗益处。未来的研究应该集中在减少并发症和进一步改进VAD技术以提高患者的预后。
Dilated cardiomyopathy (DCM) is a prevalent heart muscle disease characterized by ventricular dilation and systolic dysfunction, leading to severe heart failure (HF) and often requiring heart transplantation (HTx). This systematic
review aimed to synthesize information regarding the role of ventricular assist devices (VADs) in managing HF patients due to DCM. A comprehensive search was conducted across PubMed, Embase, Scopus, Web of Science, and Cochrane databases for studies published between 2014 and 2024. Inclusion criteria were studies involving adult patients with HF due to DCM treated with VADs. Exclusion criteria included non-human studies, pediatric populations, and non-peer-reviewed articles. Thirty-one studies met the inclusion criteria. The included studies demonstrated that the use of VADs in patients with DCM resulted in significant improvements in left ventricular ejection fraction (LVEF), myocardial fibrosis reduction, and reverse ventricular remodeling. Studies reported enhanced survival rates, reduced symptoms, and better quality of life. VADs served as a critical bridge to HTx and, in some cases, as long-term destination therapy. However, complications such as thrombus formation, anemia, and kidney failure were noted, emphasizing the need for vigilant monitoring and management. Continuous advancements in VAD technology and patient management protocols were found to be essential for optimizing outcomes. We conclude that VADs play a crucial role in managing advanced HF due to DCM by providing mechanical circulatory support, improving cardiac function, and enhancing patient survival and quality of life. Despite associated complications, VADs are invaluable for patients with severe HF, offering both immediate and long-term therapeutic benefits. Future research should focus on minimizing complications and further improving VAD technology to enhance patient outcomes.