301.2 🩺 國考版

301.2.1 高頻考點

301.2.1.1 Indications + Contraindications

  • Indications: refractory HF + EF < 25% + optimal therapy
  • Contraindications: active malignancy, severe fixed PH, substance abuse, severe comorbidities

301.2.1.2 MCS Options

  • IABP (counterpulsation, ↓ afterload)
  • Impella (microaxial)
  • Tandem Heart
  • VA-ECMO (heart + lung)
  • LVAD (HeartMate 3 = magnetic levitation centrifugal)
  • TAH (SynCardia)
  • ECPELLA (ECMO + Impella for LV decompression)

301.2.1.3 HeartMate 3 Key Trial

  • MOMENTUM 3 (2017, 2024 long-term): 5-yr survival similar to transplant for select; less thrombosis, less stroke
  • Indications: BTT, BTC, DT, BTR

301.2.1.4 LVAD Complications

  • Bleeding (#1)
  • Stroke
  • Pump thrombosis
  • Driveline infection
  • RV failure
  • AR development
  • Arrhythmia

301.2.1.5 Immunosuppression

  • Induction: ATG / basiliximab + high-dose steroids
  • Maintenance: tacrolimus (CNI) + MMF (antiproliferative) + prednisone (taper)
  • mTOR inhibitor (sirolimus, everolimus): for CAV, malignancy reduction

301.2.1.6 Rejection Surveillance

  • EMB routine (decreasing frequency)
  • AlloMap (gene expression in blood)
  • Donor-derived cfDNA emerging
  • CMR Lake Louise criteria

301.2.1.7 Cardiac Allograft Vasculopathy (CAV)

  • Top long-term cause of death
  • Diffuse intimal hyperplasia
  • Annual angiography
  • Often silent (denervated heart)
  • mTOR inhibitor for slowing

301.2.1.8 Post-Transplant Complications

  • Cardiovascular: CAV, HTN, hyperlipidemia, DM, arrhythmia
  • Infection: CMV, EBV, PJP, aspergillus, candida
  • Malignancy: skin, PTLD (EBV-driven), solid organ
  • Renal: CNI nephrotoxicity (25-30% ESRD)
  • Bone loss: steroids

301.2.1.9 Survival

  • 1-yr: 90%
  • 5-yr: 75%
  • 10-yr: 50-60%

301.2.2 易混淆比范

MCS Device Type Use Key Trial
IABP Counterpulsation Bridge in select IABP-SHOCK II (no benefit)
Impella Microaxial LV Acute MI shock, high-risk PCI DanGER-SHOCK 2024
Tandem Heart Centrifugal Severe shock Various registries
VA-ECMO Extracorporeal Refractory shock, E-CPR EOLIA, ARREST
LVAD (HM3) Centrifugal magnetic BTT, DT, BTR MOMENTUM 3
TAH Total artificial Biventricular failure SynCardia
ECPELLA ECMO + Impella LV decompression Registries

301.2.3 Special Topics

301.2.3.1 Status Listing (UNOS Updated 2018)

  • Status 1: high-acuity (MCS, severe symptoms)
  • Status 2: standard inotrope dependence
  • Status 3-7: various
  • 2018 changes: more granular for high-acuity

301.2.3.2 Pre-Transplant Pulmonary HTN

  • Reversibility critical
  • Vasodilator challenge (NO, milrinone)
  • PVR > 4-5 WU non-responsive = contraindication

301.2.3.3 Xenotransplantation

  • Pig hearts genetically modified
  • First human 2022 (Bennett, 60 days)
  • Second 2023 (Faucette, 40 days)
  • Hyperacute rejection challenge
  • 10+ gene edits typical (alpha-Gal, B4GALNT2, GHR, CMAH, etc.)