Kantrowitz A
Biomater Med Devices Artif Organs. 1976;4(1):1-20. doi: 10.3109/10731197609118642.
Use of a prosthesis for temporary or permanent circulatory support in left ventricular failure has been investigated by our group for over 12 years. Experiences with both a U-shaped mechanical auxiliary ventricle (MAV) and the intraaortic balloon pump showed that in-series devices can stabilize the failing circulation. Studies with a MAV based on the balloon pump, the dynamic aortic patch (DAP) indicated that this system too is hemodynamically effective. In addition, data from extensive in vivo studies indicated that when its intravascular surface is made of Electrolour (Dacron velour backed by polyurethane with a negative electrical charge), the frequency of thromboembolism is greatly diminished. Following initial activation of the DAP in a patient with advanced chronic congestive failure, his hemodynamic parameters rapidly approached normal values: mean pulmonary artery and end-diastolic pressures were reduced, cardiac output increased, and myocardial metabolism changed from anaerobic to aerobic. The patient's cardiac function gradually improved, allowing his return to his home. The patient died on the 96th postoperative day after three months of improved cardiac function. Autopsy disclosed the DAP to be functional. A stable fibrin layer had formed on its intravascular surface; there were no signs of embolization. The DAP represents a promising approach to long-term ventricular support. For more than twelve years, our group has been interested in the possibility of using a mechanical prosthesis, not for total heart replacement, but rather for partial temporary or permanent circulatory support. In the first several years of work following this approach, we concentrated on the development of a permanently implantable system for in-series ventricular assistance. This work led to the study of several configurations of a mechanical auxiliary ventricle which gave effective circulatory support in laboratory and clinical studies [1,2]. The problem of achieving satisfactory interaction between blood and prosthesis was not resolved in these studies, but we were sufficiently encouraged by the hemodynamic effects to look into the possibility of working with the temporary support system initially proposed by Moulopoulos, Topaz, and Kolff [3].
我们团队对使用假体进行左心室衰竭的临时或永久性循环支持进行了超过12年的研究。使用U形机械辅助心室（MAV）和主动脉内球囊泵的经验表明，串联装置可以稳定衰竭的循环。基于球囊泵的MAV即动态主动脉补片（DAP）的研究表明，该系统在血液动力学上也是有效的。此外，大量体内研究的数据表明，当其血管内表面由Electrolour（由带负电荷的聚氨酯支持的涤纶绒）制成时，血栓栓塞的频率会大大降低。在一名晚期慢性充血性心力衰竭患者首次激活DAP后，他的血液动力学参数迅速接近正常值：平均肺动脉压和舒张末期压力降低，心输出量增加，心肌代谢从无氧代谢转变为有氧代谢。患者的心脏功能逐渐改善，使其能够回家。患者在心脏功能改善三个月后的术后第96天死亡。尸检显示DAP功能正常。其血管内表面形成了一层稳定的纤维蛋白层；没有栓塞迹象。DAP是一种有前景的长期心室支持方法。十二多年来，我们团队一直关注使用机械假体的可能性，不是用于全心脏置换，而是用于部分临时或永久性循环支持。在采用这种方法的最初几年工作中，我们专注于开发一种用于串联心室辅助的永久可植入系统。这项工作导致了对几种机械辅助心室配置的研究，这些配置在实验室和临床研究中提供了有效的循环支持[1,2]。在这些研究中，血液与假体之间实现令人满意的相互作用的问题尚未解决，但血液动力学效应足以鼓励我们研究最初由穆洛普洛斯、托帕兹和科尔夫提出的临时支持系统[3]。
