nūhou

Me ka ʻelemakule o ka heluna kanaka a me ka holomua o ka maʻi maʻi maʻi cardiovascular a me ka mālama ʻana, ʻo ka maʻi ʻole o ka naʻau (ka puʻuwai puʻuwai) ʻo ia wale nō ka maʻi cardiovascular e piʻi aʻe ana i ka maʻi a me ka prevalence. ʻO ka heluna kanaka o Kina o ka maʻi maʻi puʻuwai maʻi ma 2021 ma kahi o 13.7 miliona, ua manaʻo ʻia e hiki i 16.14 miliona ma 2030, ʻo ka make ʻana o ka naʻau e hiki i ka 1.934 miliona.

Noho pū ka puʻuwai a me ka fibrillation atrial (AF). Hiki i ka 50% o nā maʻi hōʻeha puʻuwai hou i loaʻa i ka fibrillation atrial; Ma waena o nā hihia hou o ka atrial fibrillation, kokoke i hoʻokahi hapakolu i loaʻa ka puʻuwai puʻuwai. He mea paʻakikī ke hoʻokaʻawale ma waena o ke kumu a me ka hopena o ka pau ʻana o ka naʻau a me ka fibrillation atrial, akā i nā poʻe maʻi me ka puʻuwai puʻuwai a me ka atrial fibrillation, ua hōʻike ʻia kekahi mau haʻawina e hōʻemi nui ana ka catheter ablation i ka hopena o ka make a me ka heluhelu ʻana i ka naʻau. Eia naʻe, ʻaʻohe o kēia mau haʻawina i hoʻokomo i nā maʻi me ka pau ʻole o ka naʻau i hui pū ʻia me ka fibrillation atrial, a ʻo nā alakaʻi hou loa e pili ana i ka pau ʻole o ka naʻau a me ka ablation ʻo ia ka ablation ma ke ʻano he papa II no ka poʻe maʻi me kekahi ʻano o ka atrial fibrillation a me ka haʻihaʻi ejection i hoʻemi ʻia, ʻoiai ʻo amiodarone he ʻōlelo paipai Papa I.

Ua hōʻike ʻia ka haʻawina CASTLE-AF, i paʻi ʻia ma 2018, no nā poʻe maʻi me ka fibrillation atrial i hui pū ʻia me ka pau ʻole o ka naʻau, ua hōʻemi nui ka catheter ablation i ka hopena o nā kumu āpau a me ka heluhelu ʻana o ka naʻau i ka hoʻohālikelike ʻia me ka lāʻau lapaʻau. Eia kekahi, ua hōʻoia kekahi mau noiʻi i nā pono o ka catheter ablation i ka hoʻomaikaʻi ʻana i nā hōʻailona, ​​​​hoʻohuli ʻana i ka hoʻoponopono ʻana i ka naʻau, a me ka hōʻemi ʻana i ka ukana fibrillation atrial. Eia nō naʻe, ʻo nā mea maʻi me ka fibrillation atrial i hui pū ʻia me ka pau ʻole o ka naʻau o ka pae hope e hoʻokaʻawale pinepine ʻia mai ka heluna kanaka noiʻi. No kēia poʻe maʻi, ʻoi aku ka maikaʻi o ka hāʻawi ʻana i ka manawa no ka hoʻololi ʻana i ka naʻau a i ʻole ke hoʻokomo ʻana i kahi mea kōkua ventricular hema (LVAD), akā aia nō ka nele o nā hōʻike lapaʻau e pili ana i nā hōʻike e pili ana i ka hiki ke hōʻemi ʻia ka catheter ablation i ka make a hoʻopaneʻe i ka hoʻokomo ʻia ʻana o LVAD i ke kali ʻana no ka hoʻololi ʻana i ka naʻau.

ʻO ke aʻo ʻana ʻo CASTLE-HTx he kikowaena hoʻokahi, wehe-label, hoʻāʻo ʻia e ka mea noiʻi i hoʻomaka i ka hoʻāʻo ʻana o ka maikaʻi. Ua mālama ʻia ke aʻo ʻana ma ka Herz-und Diabeteszentrum Nordrhein-Westfale, kahi kikowaena hoʻololi i ka puʻuwai ma Kelemānia e hana ana ma kahi o 80 mau transplants i ka makahiki. ʻO ka huina o 194 mau maʻi me ka pau ʻole o ka naʻau me ka symptomatic atrial fibrillation i loiloi ʻia no ke kūpono no ka hoʻololi ʻana i ka naʻau a i ʻole ka LVAD implantation i kākau inoa ʻia mai Nowemapa 2020 a hiki i Mei 2022. Ua loaʻa i nā maʻi āpau nā mea naʻau implantable me ka nānā mau ʻana i ka puʻuwai puʻuwai. Hoʻokaʻawale ʻia nā mea maʻi āpau ma kahi ratio 1: 1 e loaʻa i ka catheter ablation a me ka lāʻau alakaʻi alakaʻi a i ʻole e loaʻa i ka lāʻau lapaʻau wale nō. ʻO ka hopena mua he hui o nā kumu āpau o ka make, LVAD implantation, a i ʻole ka hoʻololi ʻana o ka naʻau. ʻO nā hopena hope loa i loaʻa i nā kumu a pau o ka make, ka LVAD implantation, ka hoʻololi ʻana i ka naʻau pilikia, ka make cardiovascular, a me nā loli i ka haʻihaʻi ventricular ejection fraction (LVEF) a me ka ukana fibrillation atrial ma 6 a me 12 mau mahina o ka hahai ʻana.

I Mei 2023 (hoʻokahi makahiki ma hope o ke kākau inoa ʻana), ua ʻike ke Kōmike Kaʻi ʻIke a me ka Palekana i kahi loiloi interim he ʻokoʻa a ʻoi aku ka nui o nā hanana hope mua ma waena o nā pūʻulu ʻelua ma mua o ka mea i manaʻo ʻia, ʻoi aku ka maikaʻi o ka hui ablation catheter a me ka hoʻokō ʻana i ke kānāwai Haybittle-Peto, a ua ʻōlelo ʻia e hoʻopau koke i ke ʻano o ka lāʻau lapaʻau i kuhikuhi ʻia ma ke aʻo ʻana. Ua ʻae ka poʻe noiʻi i ka ʻōlelo aʻoaʻo a ke komite e hoʻololi i ke kaʻina noiʻi e ʻoki i ka ʻikepili hahai no ka hopena mua ma Mei 15, 2023.

Pono ka hoʻololi ʻana o ka naʻau a me ka hoʻokomo ʻana o LVAD i mea e hoʻomaikaʻi ai i ka wānana o nā maʻi me ka pau ʻole o ka naʻau i hui pū ʻia me ka fibrillation atrial, akā naʻe, ʻo nā kumu waiwai hāʻawi palena ʻole a me nā kumu ʻē aʻe e kaupalena i kā lākou noi ākea i kekahi ʻano. ʻOiai e kali ana i ka hoʻololi ʻana o ka naʻau a me kahi LVAD, he aha hou aʻe kā mākou e hana ai e hoʻolōʻihi i ka piʻi ʻana o ka maʻi ma mua o ka make ʻana? ʻO ke aʻo ʻana ʻo CASTLE-HTx he mea nui loa ia. ʻAʻole wale ia e hōʻoia hou i nā pono o ka ablation catheter no nā poʻe maʻi me ka AF kūikawā, akā hāʻawi pū kekahi i kahi ala hoʻohiki no ka hiki ke kiʻekiʻe aʻe no nā poʻe maʻi me ka pau ʻole o ka puʻuwai paʻakikī me AF.