말기 심부전의 비약물적 치료
Treatment of Advanced Heart Failure: Beyond Medical Treatment
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초록
기계적 순환 보조 장치가 최근 10여년간 말기 혹은 급성 심부전 환자의 치료에 도움이 된다는 것이 확인되어, 말기 심부전의 치료 방침에 많은 변화가 진행되고 있다. 국내에서는 경피적 순환 보조 장치인 IABP와 ECMO를 사용한 PCPS를 시행할 수 있어 심인성 쇽이나 급성 심부전 환자의 일시적인 치료에 도움을 받고 있지만, 장기적으로 사용할 수 있는 삽입형 심실 보조 장치에 대한 경험은 아직 전무한 실정이다. 향후 국내에서도 삽입형 심실 보조 장치에 대한 임상시험이 시행될 예정으로 조만간 국내에 도입되어 말기 심부전 환자의 치료에 효과적으로 사용될 수 있는 중요한 치료 수단이 될 것으로 기대된다.
Abstract
During last 2 decades, advance in the mechanical circulatory support has altered the management of end-stage heart failure and cardiogenic shock. This includes percutaneous mechanical support devices such as extracorporeal membrane oxygenator (ECMO) and implantable left ventricular assist devices (LVAD). Percutaneous devices may provide prompt circulatory support and save lives of the patients with cardiogenic shock. But for a prolonged support, long-term devices such as implantable LVAD are mandatory. LVAD is useful for both bridge-to-transplantation strategy and destination therapy for the patients with end-stage heart failure. Newer LVAD using continuous flow pump has several advantages over those with pulsatile flow pump, which includes smaller size and durability and showed better outcome in recent studies. In this manuscript, brief reviews of percutaneous and implantable devices for the management of advanced heart failure will be provided. (Korean J Med 2012;82:658-666)
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