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首页> 外文期刊>European journal of cardio-thoracic surgery: Official journal of the European Association for Cardio-thoracic Surgery >End-stage heart failure in children or patients suffering from congenital heart disease: Are new treatment options emerging?
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End-stage heart failure in children or patients suffering from congenital heart disease: Are new treatment options emerging?

机译：儿童或先天性心脏病患者的末期心力衰竭：是否正在出现新的治疗选择？

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The development and time course of end-stage heart failure in paediatric patients suffering from cardiomyopathy and in patients suffering from repaired and unrepaired congenital heart defects are different from those of the adult population, since the myocardial damage is mainly not of an ischaemic nature. Therefore, the approach needed to treat end-stage heart failure in these patient groups is different from that in aduit patients with end-stage heart failure due to coronary artery disease, cardiomyopathy or myocarditis. As in adults with acquired heart diseases, heart transplantation (HTx) and mechanical circulatory support (MCS) are the only two remaining options. However, due to issues of availability, the balance between the two options is different for children and the entire group of patients suffering from congenital heart disease (CHD). There are three major factors that most strongly impact the decision algorithm in these patients. First, due to the dramatic improvements in paediatric cardiac surgery and postoperative care, including the subsequent inter-ventional procedures, during the past decades there have been increasing numbers of patients surviving into adulthood, such as those with univentricuiar hearts, who may develop end-stage heart failure after years of nearly normal quality of life. Additionally, a significant number of adult patients who received palliative procedures as children 30-40 years ago now bear a high risk of congestive myocardial failure; many of them are adults who underwent Senning and Mustard repair of transposition of the great arteries or Fontan procedures in childhood,Secondly, the number of paediatric HTx has stagnated while the need for donor organs continuously increases. Finally, the experience with MCS lasting beyond 5 years is limited and no patients, even adults, have been supported for >8 years, whereas many children survive for >20 years after HTx.
机译：患心肌病的小儿患者以及患有修复和未修复的先天性心脏缺陷的患者的终末期心力衰竭的发展和时程与成年人不同，因为心肌损伤主要不是缺血性的。因此，在这些患者组中，治疗末期心力衰竭所需的方法与因冠心病，心肌病或心肌炎而患有末期心力衰竭的ad愈患者不同。与成人后天性心脏病一样，心脏移植（HTx）和机械循环支持（MCS）是仅有的两个选择。但是，由于可用性问题，对于儿童以及患有先天性心脏病（CHD）的整个患者组，这两种选择之间的平衡是不同的。影响这些患者决策算法的三个主要因素。首先，由于小儿心脏手术和术后护理（包括随后的介入手术）的显着改善，在过去的几十年中，成年后存活的患者数量不断增加，例如单心室的患者可能经过数年几乎正常的生活质量后分期心力衰竭。另外，现在有大量成年患者在30至40年前接受姑息治疗，但他们充血性心肌衰竭的风险却很高。他们中的许多人是成年人，他们在童年时期接受了Senning和Mustard修复大动脉或Fontan手术的移位。其次，小儿HTx的数量停滞了，而对供体器官的需求却不断增加。最后，持续5年以上的MCS经验是有限的，甚至8岁以上的患者（甚至成人）都没有得到支持，而HTx后许多儿童的生存期超过了20年。

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