Pennington D G, Smedira N G, Samuels L E, Acker M A, Curtis J J, Pagani F D
Department of Surgery, East Tennessee State University, Johnson City 37614, USA.
Ann Thorac Surg. 2001 Mar;71(3 Suppl):S56-9; discussion S82-5. doi: 10.1016/s0003-4975(00)02642-4.
Circulatory support devices are frequently required in postcardiotomy shock, postmyocardial infarction shock, and acute myocarditis. A panel of cardiac surgeons addressed the use of these devices in 4 patients. Cardiogenic shock after mitral valve replacement was considered best served by a left ventricular assist device (VAD) with apical rather than atrial cannulation. A left VAD should be placed first and a right VAD only if needed. Acute myocardial infarction shock was considered best treated with a left VAD with left ventricular cannulation to avoid thrombosis. If cardiac transplantation is an option, a long-term device must be considered. Young patients with acute fulminant myocarditis should be implanted with VADs in anticipation of recovery, and transplantation should be delayed. Patients with severe heart failure after coronary bypass grafting were considered best served by an extracorporal membrane oxygenation (ECMO) system or a VAD. Current postcardiotomy survival rates of postcardiotomy patients of 20% to 40% are worthwhile, but can be improved. Temporary devices such as ECMO can be changed to more long-term devices when necessary.
心脏手术后休克、心肌梗死后休克和急性心肌炎患者常常需要循环支持设备。一组心脏外科医生讨论了在4例患者中使用这些设备的情况。二尖瓣置换术后的心源性休克，使用心尖插管而非心房插管的左心室辅助装置（VAD）被认为是最佳选择。应首先放置左VAD，仅在必要时放置右VAD。急性心肌梗死休克，使用左心室插管的左VAD进行治疗被认为是最佳选择，以避免血栓形成。如果心脏移植是一种选择，则必须考虑使用长期设备。患有急性暴发性心肌炎的年轻患者应植入VAD以期恢复，并且应推迟移植。冠状动脉搭桥术后严重心力衰竭的患者，使用体外膜肺氧合（ECMO）系统或VAD被认为是最佳选择。目前心脏手术后患者20%至40%的生存率是值得肯定的，但仍有提高的空间。必要时，诸如ECMO等临时设备可以更换为更长期的设备。
