Vitali Ettore, Lanfranconi Marco, Ribera Elena, Bruschi Giuseppe, Colombo Tiziano, Frigerio Maria, Russo Claudio
Department of Cardiac Surgery A. De Gasperis, Niguarda Ca' Granda Hospital, Milan, Italy.
Ann Thorac Surg. 2003 Apr;75(4):1200-4. doi: 10.1016/s0003-4975(02)04660-x.
Pulsatile left ventricular assist devices are used with increasing frequency to bridge patients with end-stage heart failure to heart transplantation (HTx). Implantation of pulsatile devices is a cumbersome surgical procedure that is associated with major complications, such as bleeding, thromboembolism, and infection. Recently, a continuous axial flow left ventricular assist device (DeBakey ventricular assist device) has been introduced with the goal of reducing the incidence of major complications.
We reviewed our experience with 11 patients who received a DeBakey ventricular assist device axial flow pump for bridge to HTx from April 2000 through November 2001.
Two patients (18.2%) died of multiple-organ failure while on left ventricular assist device support. Bleeding requiring thoracotomy occurred in 2 patients (18.2%). One patient had a minor neurologic event, and one patient developed left ventricular assist device thrombosis, which was successfully treated without pump exchange. Renal failure developed in 1 patient and hepatic dysfunction in 2 patients. There were no instances of right heart failure. No device, pocket, or drive-line infections occurred. Nine patients (9 of 11, 81.8%) had HTx within 51 +/- 49 days (range, 11 to 141 days) after left ventricular assist device implant. One patient died 29 days after HTx because of acute rejection.
The continuous axial flow DeBakey ventricular assist device had reliable features, including a high rate of bridge to HTx. This device had low complication and system failure rates. We consider the DeBakey ventricular assist device a favorable alternative to pulsatile heart assist devices as a bridge to HTx.
搏动性左心室辅助装置越来越频繁地用于将终末期心力衰竭患者过渡到心脏移植（HTx）。搏动性装置的植入是一种繁琐的外科手术，会引发诸如出血、血栓栓塞和感染等严重并发症。最近，一种连续轴流式左心室辅助装置（德巴基心室辅助装置）被引入，目的是降低严重并发症的发生率。
我们回顾了2000年4月至2001年11月期间11例接受德巴基心室辅助装置轴流泵以过渡到HTx的患者的治疗经验。
两名患者（18.2%）在接受左心室辅助装置支持期间死于多器官功能衰竭。两名患者（18.2%）发生了需要开胸手术的出血。一名患者发生了轻微神经系统事件，一名患者发生了左心室辅助装置血栓形成，经治疗成功，无需更换泵。一名患者出现肾衰竭，两名患者出现肝功能障碍。未发生右心衰竭情况。未发生装置、囊袋或驱动线感染。9名患者（11名中的9名，81.8%）在植入左心室辅助装置后51±49天（范围11至141天）内接受了HTx。一名患者在HTx后29天因急性排斥反应死亡。
连续轴流式德巴基心室辅助装置具有可靠的特性，包括较高的过渡到HTx的成功率。该装置并发症和系统故障率低。我们认为德巴基心室辅助装置作为过渡到HTx的手段是搏动性心脏辅助装置的一个有利替代方案。
