Farrar D J
Thoratec Laboratories Corporation, Pleasanton, CA 94588, USA.
Semin Thorac Cardiovasc Surg. 2000 Jul;12(3):243-50. doi: 10.1053/stcs.2000.19620.
The Thoratec Ventricular Assist Device (VAD) System (Thoratec Laboratories, Pleasanton, CA) is a paracorporeal pump that can provide univentricular or biventricular assistance for patients with heart failure. The system consists of a prosthetic ventricle that has a blood-pumping chamber of Thoralon (Thoratec Laboratories) polyurethane, cannulas for univentricular or biventricular support, and either a hospital-based pneumatic drive console or a portable battery-powered drive unit. For biventricular assistance, 2 pumps are used. The Thoratec voluntary registry indicates that, as of May 2000, this system had been implanted in 1,376 patients, mainly for bridging to transplantation (828 patients) or postcardiotomy support (195 patients); the remaining 353 patients received a hybrid configuration of the device or had incomplete information, so they are not included in this analysis. In the 828 bridge-to-transplant patients, the Thoratec system provided biventricular assistance in 472 cases, left ventricular assistance in 326 cases, and right ventricular assistance in 30 cases for up to 515 days. During the support period, the cardiac index increased significantly from 1.4 +/- 0.8 L/min/m2 to 3.0 +/- 0.5 L/min/m2 (with biventricular assistance and left ventricular cannulation). Sixty percent of the 828 patients underwent transplantation, and the posttransplant survival rate was 86%. In the 195 patients who needed postcardiotomy support, VADs were used for up to 80 days for cardiac recovery. Thirty-eight percent of the patients were weaned from the VAD, and 59% of the weaned group were discharged from the hospital. In addition, 49 postcardiotomy patients were considered for transplantation; of these, 32 received a transplant and 23 were discharged. Patient mobility is being improved by the use of a portable driver. The Thoratec VAD is suitable for a wide range of applications, and efforts are underway to facilitate patient mobility and allow hospital discharge. An intracorporeal version of the VAD, which is currently under development, will help achieve these goals.
Thoratec心室辅助装置（VAD）系统（Thoratec实验室，加利福尼亚州普莱森顿）是一种体外泵，可为心力衰竭患者提供单心室或双心室辅助。该系统由一个人工心室组成，其血泵腔由Thoratec实验室的Thoralon聚氨酯制成，有用于单心室或双心室支持的插管，以及一个医院用的气动驱动控制台或一个便携式电池驱动单元。对于双心室辅助，使用2个泵。Thoratec自愿登记处表明，截至2000年5月，该系统已植入1376例患者体内，主要用于过渡到移植（828例患者）或心脏切开术后支持（195例患者）；其余353例患者接受了该装置的混合配置或信息不完整，因此未纳入本分析。在828例过渡到移植的患者中，Thoratec系统在472例中提供双心室辅助，在326例中提供左心室辅助，在30例中提供右心室辅助，最长达515天。在支持期间，心脏指数从1.4±0.8升/分钟/平方米显著增加到3.0±0.5升/分钟/平方米（双心室辅助和左心室插管）。828例患者中有60%接受了移植，移植后生存率为86%。在195例需要心脏切开术后支持的患者中，VAD用于心脏恢复最长达80天。38%的患者脱离了VAD，脱离VAD组中有59%出院。此外，49例心脏切开术后患者被考虑进行移植；其中32例接受了移植，23例出院。便携式驱动器的使用正在改善患者的活动能力。Thoratec VAD适用于广泛的应用，目前正在努力促进患者活动能力并允许出院。目前正在研发的VAD体内版本将有助于实现这些目标。
