<International Circulation>:  How do you decide when to implant a ventricular assist device (VAD)?

　　《国际循环》：目前很难选择心力衰竭的治疗方法，因为我认为没有很好的数据证实设备或药物治疗何者的效果更好。您是如何决定行植入VAD（心室辅助装置）还是仅仅行药物治疗的？
　　Dr Konstam: VADs are assist devices generally reserved at this point for very sick patients and patients with very advanced disease. There is an interest in migrating them towards less sick patients.  There is a trial that either has started or very soon will start looking to see whether they can be migrated as a favorable utility in less sick patients. Based on the current generation of VADs， I am skeptical about that because I think that， while the continuous flow VADs， axial flow pumps and centrifugal flow pumps that we have right now are better and more reliable than the first generation (the displacement pumps which were clunkier and had shorter life spans)， they are still very complex devices with significant comorbidities.The driveline is externalized and can be associated with driveline infections. They are prone to thrombotic events. They are prone to mechanical dysfunction and the care for such patients is really limited to specialized centers. So personally， I am skeptical that the present generation of VADs is going to be translatable to a much broader population. However， projections are that this is the direction in which things will happen. I think those projections， to a large extent， are based on the assumption that there is going to be a new generation of VADs that have: even fewer comorbidities associated with them， are easier to maintain， are more reliable， less prone to thrombotic events， and， in particular， able to be rid of the driveline. I know there is work being done on transcutaneous power transduction， for instance. If we can ever get there and get rid of the driveline， that would be a big move in the right direction. It is an annoyance， the user has to carry the battery pack， and the infection rate is substantial. The patients themselves have to be quite sophisticated to properly care for it. It is really hard for me to visualize a much less sick patient having the case made to them that this is what they should do for a lot of reasons， but certainly one of them is the driveline.

心力衰竭的VAD治疗

    VAD（心室辅助装置）通常用于极度衰弱及伴有晚期疾病的心力衰竭患者，目前研究正在不断拓宽其应用人群。虽然目前我们所拥有的持续血流VAD、轴流泵以及离心式水泵要优于第一代容积式泵，但它们仍然存在系统感染、引发血栓事件等问题。因此，我对现有VAD在更广范围人群中的应用持谨慎态度。

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