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首页> 外文期刊>Artificial Organs >Clinical and Molecular Comparison of Pediatric and Adult Reverse Remodeling With Ventricular Assist Devices
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Clinical and Molecular Comparison of Pediatric and Adult Reverse Remodeling With Ventricular Assist Devices

机译：使用心室辅助装置进行小儿和成人逆重塑的临床和分子比较

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Ventricular assist device (VAD) support induces reverse remodeling of failing myocardium that leads to occasional functional recovery of the adult heart. While there have been numerous clinical reports in adult patients with end-stage cardiomyopathy, little is known about reverse remodeling in children, which has increasing clinical potential with the recent expansion of pediatric VADs in the setting of static organ supply for heart transplantation. Pediatric myocardium also promises theoretical advantages for recovery over adult myocardium due to its greater abundance of cardiac progenitor cells. To identify potential targets of future studies, we conducted a literature review with two aims: (i) to summarize clinical cases of pediatric patients who exhibited cardiac recovery following VAD support; and (ii) to analyze genetic changes in pediatric myocardium induced by VAD support compared with those observed in adult patients. Several clinical series of pediatric VAD cases report that small proportions of their cohorts were weaned off from device support, but a lack of information about the etiology and support duration of these patients limits the ability to determine whether they represent reverse remodeling of myocardial structure or just recovery from acute illness. A comparison of pediatric and adult gene expression changes with VAD support reveals approximately 40% of genes to be oppositely regulated, indicating that the pediatric genetic response is distinct. These observations highlight a necessity to better understand reverse remodeling specific to pediatric myocardium, which is crucial to improving clinical strategies for bridge-to-recovery in children.
机译：心室辅助装置（VAD）的支持引起心肌衰竭的逆重塑，导致成年心脏偶尔恢复功能。尽管有成年期终末期心肌病的成年患者的临床报道很多，但对儿童逆向重构的了解却很少，随着近期儿科VAD在心脏移植的静态器官供应方面的发展，其临床潜力越来越大。小儿心肌由于其丰富的心脏祖细胞，也有望在理论上优于成年心肌。为了确定未来研究的潜在目标，我们进行了两个目的的文献综述：（i）总结在VAD支持下表现出心脏恢复的小儿患者的临床病例; （ii）分析与成人患者观察到的相比，VAD支持诱发的小儿心肌的遗传变化。几项小儿VAD临床病例报告表明，他们的一小部分队列已从设备支持中撤离，但是缺乏有关这些患者的病因和支持持续时间的信息，限制了他们确定其代表心肌结构逆向重构的能力还是仅仅是从急性疾病中恢复。 VAD支持下的儿科和成年基因表达变化的比较显示，约有40％的基因被相反地调节，表明儿科的遗传反应是不同的。这些观察结果表明，有必要更好地理解小儿心肌特有的反向重塑，这对于改善儿童过渡至康复的临床策略至关重要。

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