vad应用与现状.ppt
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vad应用与现状.ppt
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CurrentStatusofVADApplicationforHeartFailureinChina心脏辅助装置(VAD)在心衰外科治疗的应用现状FengWan万峰ChairmanandProfessorDept.ofCardiovascularSurgeryatPekingUniversity北京大学心血管外科学系,北京大学第三医院心脏外科Sino-HeartGroup神州海德集团2014InternationalHeartFailureConferencinChangsha,心衰自然史NaturalHistoryofHeartFailure,Jessup,NEJM2003;348:
2007,USA:
Total5,000,000CHF,onlyincreasing.700,000newcases/yr.1,000,000pt.hospitalization/yr.250,000died/yr.Etiology:
Ischemic:
70%ofCHFIdiopathicCardiomyopathy:
13%Hypertension:
7%China:
4,500,000CHF500,000newcases/yr.Etiology:
Coronary:
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CHFTherapy,PhysicalRehabilitation-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&Psych.Therapy-社会和精神疗法等等Unique,combined,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PrincipalofTherapy,ClassificationofISHLT,Level-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,VAD,VADHistory:
40Years,GoalsofVAD,BridgeToRecovery(BTC)恢复的桥梁BridgeToTransplantation(BTT)移植的桥梁DestinationTherapy(DT)终期永久植入Asanalternativetotransplantation,BridgeToDecision(BTD)决策的桥梁,应用于二种完全不同的情况:
StrategyofVAD,CardiogenicShock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-usingimplantabledevices.Permanentusetoprolonglife.notransplantationtocome-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,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SupportDevices,长期辅助的指证CurrentIndicationsforLong-termMCSTherapy,BridgetoTransplantation心脏移植的桥梁listedforhearttransplantationClassIVheartfailureatriskofimminentdeathmaximalmedicaltherapyDestinationTherapy(Permanentuseofdevicesasanalternativetohearttransplantation永久植入作为心脏移植的替代)persistentNYHAclassIVsymptomsorIIIBwithinotropesupportfor45oftheprevious60dayswithoptimalmedicalmanagementLVEF25%peakoxygenconsumption14mLkg1min1notacandidateforhearttransplantation,SuccessfulVADProgram,PatientSelection病人选择Pre-OperativeManagementandOptimization术前管理和调整IntraoperativeTechniques手术技术Post-OperativeCare术后监护和管理,VentricularAssistDeviceInnovation,1stGeneration,3rdGeneration,2ndGeneration,PulsatileTechnology,ContinuousFlowTechnologyAxialDesign,ContinuousFlowTechnologyCentrifugalDesign,Minaturization小型Durability耐久,FDAApprovedBTT1998DT2002,FDAApprovedBTT2008DT2010,Investigational,Bearings,Bearingswithstator,Bearinglesswithmagneticlevitation,ImprovementinPatientSurvival,HM-IIWorldwideClinicalExperience*,Patientssupported12years:
3895Patientssupported23years:
802Patientssupported34years:
336Patientssupported45year:
131Patientssupported56years:
69Patientssupported67years:
16Patientssupported78years:
5Patientssupported9years:
1,Morethan10,000patientsworldwidehavenowbeenimplantedwiththeHeartMateIILVAS.,*Basedonclinicaltrialanddevicetrackingdata,ThoratecHMIIregistry2013,VentricularAssistDeviceInnovationNewDevicesinClinicalTrials,HeartMateIII,HeartMateX,HeartWare,Newdesigns,AxialCFpumpTominiCentrifugalpumps,Carmat:
TAH?
OurVADExperience,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-80in1989atSurgicalResearchCenter,UniversityParisXII,France,Bi-VADimplantin1989atHenri-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1998-1stBi-VADImplantinChinaatQingdaoStarrInterlHosp,19991stL-VADinChinaatPost-TelecomGenHospital,Beijing1999-中国首例左室辅助装置植术在北京邮电总院成功,Training,Research,Implantation,2000-09-21atPekingUniversity,Training,Research,Implantation,MedosL-VADSystematPekingUniversityHospital,Fu-WaiHospital2004,VADusedinChina,Dr.WansGroupFu-WaiHospitalOthers,2003,BerlinHeart,Dr.WansSHGPKUGroup1998,Chinese-madeVADAnimalTestDr.Li,FuWai,WansPKUGroup2012,ShanghaiLiusGroup2005,国产VAD研发情况一览,“ChinesePump”-中国心,Type(2004),FunctionallyTotalArtificialHeart(LGR-TAH),“长治久安人工心脏”-长治市人工心脏研发中心,“ChinesePump”-中国心,Ho
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