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1、Current Status of VAD Application for Heart Failure in China 心脏辅助装置（VAD）在心衰外科治疗 的应用现状Feng Wan 万 峰 Chairman and Professor Dept. of Cardiovascular Surgery at Peking University 北京大学心血管外科学系，北京大学第三医院心脏外科 Sino-Heart Group 神州海德集团2014 International Heart Failure Conferenc in Changsha,心衰自然史 Natural History o
2、f Heart Failure,Jessup, NEJM 2003;348:2007,USA: Total 5,000,000 CHF, only increasing. 700,000 new cases/yr. 1,000,000 pt. hospitalization/yr. 250,000 died/yr. Etiology: Ischemic: 70% of CHF Idiopathic Cardiomyopathy: 13% Hypertension: 7% China: 4,500,000 CHF 500,000 new cases/yr. Etiology: Coronary:
3、 46% Rhumatic: 18% Hypertension, Cardiomyopathy, Congenital, ect.,背景 Background,心力衰竭患者占心血管病房 收治量35-45%，重症患者多见,心衰治疗方法 CHF Therapy,Physical Rehabilitation -体能康复治疗 Medical Therapy-药物治疗 Surgical Therapy-“End-stage Heart Dis.“-外科治疗-最具挑战和最后的战场 Social & Psych. Therapy-社会和精神疗法等等 Unique, combined, individual
4、ized Therapy-特异、综合、个体化的系统治疗方案,Correct the cause (index event)：治疗原发病变- Coronary artery disease - CABG- Structural valve disease - Valve replacement / repairCorrect the consequences of LV remodelling(secondary damage) 纠正继发病变- LV restauration Replace 置换/替代- Transplantation- Heart assist devices,治疗原则 Pr
5、incipal of Therapy,Classification of ISHLT,Level-1: crash and burn -灾难急救期 Level-2: sliding on IV inotropes -静脉正性肌力药仍恶化 Level-3: dependant stability stable on inotropes-靠正性肌力药稳定 Level-4: frequent flyer -反复发作住院 Level-5: housebound -在家里活动 Level-6: walking wounded -可外出活动,VAD,VAD History： 40 Years,Goals
6、of VAD,Bridge To Recovery（BTC）恢复的桥梁Bridge To Transplantation（BTT）移植的桥梁Destination Therapy（DT）终期永久植入 As an alternative to transplantation,Bridge To Decision（BTD）决策的桥梁,应用于二种完全不同的情况：,Strategy of VAD,Cardiogenic Shock 心源性休克- life saving procedure -救命 - using extra corporeal devices -体外装置- to permit surv
7、ival until transplantaton or recovery -等待移植或恢复,Advanced Cardiac Failure 进行性心衰- in stable patients -稳定的择期病人- using implantable devices. Permanent use to prolong life.no transplantation to come -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,restore immediatly hemodynamics and metabolism-立即重建血流动力学和新陈代谢save the brain -挽
8、救大脑、肾脏等重要脏器give time to evaluate a reasonable strategy: recovery, transplantation or last therapy -有时间制定合理的战略：恢复、移植、永久植入with an friendly user and rapid technique, which really gives time -有熟练团队、快速技术，争取到有价值的时间,辅助目标 Target of Support,急危重心衰病人的现行生命支持技术,ECMO：越来越常用- 随时随地可用，且不贵，能快速安装.- 但通常并不能完全终止恶化的时钟：病人任然
9、卧床限制，移植或置换仍然紧急,Bi-VAD：积极研发、培训、应用、推广- 技术成熟，辅助完全 - 给予充分所需的时间,IABP：常用- 有一点帮助（特别是缺血性病人，20% 左右的改善）- 对需要完全辅助的病人是不够的，可能丧失关键的时间 !,急性辅助装置 Support Devices,长期辅助的指证 Current Indications for Long-term MCS Therapy,Bridge to Transplantation 心脏移植的桥梁 listed for heart transplantation Class IV heart failure at risk of
10、imminent death maximal medical therapy Destination Therapy (Permanent use of devices as an alternative to heart transplantation 永久植入作为心脏移植的替代) persistent NYHA class IV symptoms or IIIB with inotrope support for 45 of the previous 60 days with optimal medical management LVEF 25% peak oxygen consumpti
11、on 14 mL kg1 min1 not a candidate for heart transplantation,Successful VAD Program,Patient Selection病人选择 Pre-Operative Management and Optimization术前管理和调整 Intraoperative Techniques手术技术 Post-Operative Care术后监护和管理,Ventricular Assist Device Innovation,1st Generation,3rd Generation,2nd Generation,Pulsati
12、le Technology,Continuous Flow Technology Axial Design,Continuous Flow Technology Centrifugal Design,Minaturization 小型 Durability 耐久,FDA Approved BTT 1998 DT 2002,FDA Approved BTT 2008 DT 2010,Investigational,Bearings,Bearings with stator,Bearingless with magnetic levitation,Improvement in Patient Su
13、rvival,HM-II Worldwide Clinical Experience*,Patients supported 12 years: 3895 Patients supported 23 years: 802 Patients supported 34 years: 336 Patients supported 45 year: 131 Patients supported 56 years: 69 Patients supported 67 years: 16 Patients supported 78 years: 5 Patients supported 9 years: 1
14、,More than 10,000 patients worldwide have now been implanted with the HeartMate II LVAS.,*Based on clinical trial and device tracking data,Thoratec HM II registry 2013,Ventricular Assist Device Innovation New Devices in Clinical Trials,HeartMate III,HeartMate X,HeartWare,New designs,Axial CF pump To
15、 mini Centrifugal pumps,Carmat: TAH ?,Our VAD Experience,心脏移植和 VAD装置培训 1988-1990 在法国巴黎第12大学医学院,Jarvik-80 in 1989 at Surgical Research Center, University Paris XII, France,Bi-VAD implant in 1989 at Henri-Mondor, Paris, France,Training, Research, Implantation,Training, Research, Implantation,1998-中国首例双室辅助装置植入术在青岛思达国际心脏医院 1998-1st Bi-VAD Implant in China at Qingdao Starr Interl Hosp,1999 1st L-VAD in China at Post-Telecom Gen Hospital, Beijing 1999-中国首例左室辅助装置植术在北京邮电总院成功,Training, Research, Implantation,2000-09-21 at Peking University,Training, Research, Implantation,
