Ngokuguga kwenani labantu kanye nokuthuthuka kokuxilongwa nokwelashwa kwezifo zenhliziyo, ukwehluleka kwenhliziyo okungapheli (ukwehluleka kwenhliziyo) ukuphela kwesifo senhliziyo esanda kukhula kanye nokusabalala. Inani labantu baseShayina leziguli ezinesifo senhliziyo ezingamahlalakhona ngo-2021 cishe izigidi eziyi-13.7, kulindeleke ukuthi lifinyelele ezigidini eziyi-16.14 ngonyaka ka-2030, ukufa kwenhliziyo kuzofinyelela ezigidini eziyi-1.934.
Ukuhluleka kwenhliziyo kanye ne-atrial fibrillation (AF) kuvame ukuhlala ndawonye. Kufika ku-50% weziguli ezintsha zokuhluleka kwenhliziyo zine-atrial fibrillation; Phakathi kwezimo ezintsha ze-atrial fibrillation, cishe ingxenye eyodwa kwezintathu inokwehluleka kwenhliziyo. Kunzima ukuhlukanisa phakathi kwembangela kanye nomphumela wokuhluleka kwenhliziyo kanye ne-atrial fibrillation, kodwa ezigulini ezinesifo senhliziyo kanye ne-atrial fibrillation, ucwaningo oluningana luye lwabonisa ukuthi ukukhishwa kwe-catheter kunciphisa kakhulu ingozi yokufa yonke imbangela kanye nokuhluleka kwenhliziyo ukufunda. Kodwa-ke, akekho kulezi zifundo ezihlanganisa iziguli ezine-fibrillation yokuphela kwesigaba sokuphela okuhlangene ne-fibrillation ye-atrial, futhi imihlahlandlela yakamuva kakhulu ekuhlulekeni kwenhliziyo kanye nokukhishwa kwe-ablation ihlanganisa ukukhishwa njengesiphakamiso se-Class II ezigulini ezinanoma yiluphi uhlobo lwe-fibrillation ye-atrial kanye nengxenye encishisiwe ye-ejection, kuyilapho i-amiodarone iyisincomo se-Class I.
Ucwaningo lwe-CASTLE-AF, olwanyatheliswa ngo-2018, lwabonisa ukuthi ezigulini ezine-atrial fibrillation ehlanganiswe nokuhluleka kwenhliziyo, ukukhishwa kwe-catheter kunciphisa kakhulu ingozi yokufa okubangelwa yizo zonke izinkinga kanye nokuhluleka kwenhliziyo ukufunda uma kuqhathaniswa nemithi. Ngaphezu kwalokho, ucwaningo oluningi luye lwaqinisekisa izinzuzo zokukhishwa kwe-catheter ekuthuthukiseni izimpawu, ukuguqula ukuguqulwa kwenhliziyo, nokunciphisa umthwalo we-atrial fibrillation. Kodwa-ke, iziguli ezine-fibrillation ye-atrial kuhlangene nokuhluleka kwenhliziyo kwesigaba sokuphela ngokuvamile azifakwa kubantu bocwaningo. Kulezi ziguli, ukudluliselwa okufika ngesikhathi kokufakelwa kwenhliziyo noma ukufakwa kwe-left ventricular assist device (LVAD) kuyasebenza, kodwa kusenokuntuleka kobufakazi bezokwelapha obusekelwe ebufakazini bokuthi ukukhishwa kwe-catheter kunganciphisa ukufa futhi kubambezele ukufakwa kwe-LVAD ngenkathi kulinde ukufakelwa kwenhliziyo.
Ucwaningo lwe-CASTLE-HTx bekuyisikhungo esisodwa, ilebula evulekile, isilingo esilawulwa ngokungahleliwe esiqaliswe umphenyi sokusebenza okuphakeme. Ucwaningo lwenziwa e-Herz- und Diabeteszentrum Nordrhein-Westfale, isikhungo sokudlulisela ukufakelwa kwenhliziyo eJalimane esenza ukufakelwa kabusha okungaba ngu-80 ngonyaka. Ingqikithi yeziguli ze-194 ezinokuhluleka kwenhliziyo kwesigaba sokuphela ezinezimpawu ze-atrial fibrillation ezahlolwa ukuthi zifaneleka yini ukufakelwa inhliziyo noma ukufakelwa kwe-LVAD zabhaliswa kusukela ngoNovemba 2020 kuya kuMeyi 2022. Zonke iziguli zazinamadivayisi enhliziyo afakelwayo anokuqapha okuqhubekayo kwesigqi senhliziyo. Zonke iziguli zazingahleliwe ngesilinganiso esingu-1:1 ukuze zithole ukukhishwa kwe-catheter kanye nemithi eqondiswe isiqondiso noma zithole imithi yodwa. Isiphetho esiyinhloko sasiyinhlanganisela yazo zonke izizathu zokufa, ukufakwa kwe-LVAD, noma ukufakelwa kwenhliziyo okuphuthumayo. Iziphetho zesibili zihlanganisa ukufa kwembangela yonke, ukufakwa kwe-LVAD, ukufakelwa kwenhliziyo okuphuthumayo, ukufa kwenhliziyo, kanye nezinguquko engxenyeni ye-left ventricular ejection (LVEF) kanye nomthwalo we-atrial fibrillation ku-6 nezinyanga ze-12 zokulandelela.
NgoMeyi 2023 (unyaka owodwa ngemva kokubhaliswa), iKomidi Lokuqapha Idatha Nokuphepha lathola ekuhlaziyeni kwesikhashana ukuthi izehlakalo eziyinhloko zokuphela phakathi kwamaqembu amabili zazihluke kakhulu futhi zikhulu kunalokho obekulindelwe, ukuthi iqembu lokukhishwa kwe-catheter lalisebenza kahle kakhulu futhi lihambisana nomthetho we-Haybittle-Peto, futhi lancoma ukuthi kuqedwe ngokushesha uhlobo lwezidakamizwa olubekwe ocwaningweni. Abaphenyi bamukele isincomo sekomiti sokushintsha umthetho olandelwayo wocwaningo ukuze kuncishiswe idatha yokulandelela yesiphetho esiyinhloko ngoMeyi 15, 2023.
Ukufakelwa kwenhliziyo kanye nokufakwa kwe-LVAD kubalulekile ukuze kuthuthukiswe ukubikezelwa kweziguli ezinokuhluleka kwenhliziyo ekupheleni okuhlangene ne-fibrillation ye-atrial, noma kunjalo, izinsiza ezilinganiselwe zomnikeli nezinye izici zinciphisa ukusetshenziswa kwazo okubanzi ngezinga elithile. Ngenkathi silinde ukufakelwa kwenhliziyo kanye ne-LVAD, yini enye esingayenza ukunciphisa ukuqhubeka kwesifo ngaphambi kokuba kungene ukufa? Ucwaningo lwe-CASTLE-HTx ngokungangabazeki lubaluleke kakhulu. Akugcini nje ngokuqinisekisa izinzuzo zokukhishwa kwe-catheter ezigulini ezine-AF ekhethekile, kodwa futhi inikeza indlela ethembisayo yokufinyeleleka okuphezulu ezigulini ezinokwehluleka kwenhliziyo kwesigaba sokuphela okuyinkimbinkimbi ne-AF.
Isikhathi sokuthumela: Sep-02-2023