Miniauskas Saulius, Rucinskas Kestutis, Rasimavicius Gintaras, Sirvydis Vytautas
Heart Surgery Center, Vilnius University, Santariskiu 2, 2021 Vilnius, Lithuania.
Medicina (Kaunas). 2004;40 Suppl 1:61-5.
Over the last three decades, the results of heart surgery have significantly improved. However, the number of patients at the last stages of heart deficiency has increased. Prevention provided to the patients suffering from heart diseases has improved the quality of their life and increased their lifetime. In spite of that, most of these patients sooner or later need a surgical treatment: heart surgery operation or heart transplantation. The visible damage to haemodynamics of the patients waiting for heart operations and particularly heart transplantations or after them has drawn the focus of heart surgeons to the mechanical systems of heart assist. In many cases they help to cure patients after post-cardiotomic or post-transplant cardiogenic progressive circulation and poly-organic deficiency. They also are regarded effective as a bridge to heart transplantation. In the Heart Surgery Center of Vilnius University, heart assist has been applied since 1976. Contrapulsation with intraaortic balloon pump has been applied to 856 patients, which after heart operations have developed progressive heart deficiency. Four methods of balloon insertion into aorta were used: through the a. iliaca incision (337 cases); through the a. femoralis punction (287 cases); through the ascending aorta (171 cases) and through the ascending aorta using tourniquets (61 cases). The best results were achieved employing intraaortic balloon pump after aorta-coronary bypass surgery: 67% patients were discharged from hospital. The worst results follow heart transplants, as intraaortic balloon pump was successful only to 28% of patients. In general, the total number of patients to whom the heart assist method was successful is 454 (53%). The second heart assist method that has been applied in our centre is the use of extracorporeal membranous oxigenator. It has been employed since 1998 to the patients with the critical respiration and heart deficiency. Extracorporeal membranous oxigenator has been used to 8 patients, to whom pharmaceutical treatment and intraaortic balloon pump were inefficient. Unfortunately, only one of the patients after 105 days was successfully disconnected from the extracorporeal membranous oxigenator, while maintaining his good haemodynamics. The third method of heart assist is the employment of artificial Berlin Heart ventricles. From 1999 up to 2003, 15 artificial Berlin Heart ventricles have been connected to thirteen patients, 7 of them as a bridge to heart transplant. One of the patients has already lived for over 2 years, while 6 patients had heart transplantation. There have been 8 post-cardiotomic patients with incorporated artificial Berlin Heart ventricles. The most experience has been accumulated in the use of intraaortic balloon pump. The fact that 53% of patients were discharged from hospital after such treatment indicates its efficiency. We have little experience in the employment of extracorporeal membranous oxigenator, therefore it is difficult to make conclusions. Whereas the application of Berlin Heart artificial ventricles is an effective method of assist circulation (heart assist), being a bridge to heart transplantation and effective in a long-term treatment.
在过去三十年中，心脏手术的结果有了显著改善。然而，处于心脏功能不全最后阶段的患者数量却有所增加。为心脏病患者提供的预防措施改善了他们的生活质量并延长了寿命。尽管如此，这些患者中的大多数迟早需要手术治疗：心脏手术或心脏移植。等待心脏手术尤其是心脏移植的患者或术后患者的血流动力学明显受损，这已将心脏外科医生的注意力吸引到心脏辅助机械系统上。在许多情况下，它们有助于治愈心脏切开术后或移植后心源性进行性循环和多器官功能不全的患者。它们也被视为心脏移植的有效桥梁。自1976年以来，维尔纽斯大学心脏外科中心就开始应用心脏辅助。主动脉内球囊反搏已应用于856例心脏手术后出现进行性心脏功能不全的患者。使用了四种将球囊插入主动脉的方法：通过髂动脉切口（337例）；通过股动脉穿刺（287例）；通过升主动脉（171例）以及使用止血带通过升主动脉（61例）。在冠状动脉搭桥手术后使用主动脉内球囊反搏取得了最佳效果：67%的患者出院。心脏移植后的效果最差，因为主动脉内球囊反搏仅对28%的患者成功。总体而言，心脏辅助方法成功应用的患者总数为454例（53%）。我们中心应用的第二种心脏辅助方法是使用体外膜肺氧合器。自1998年以来，它已应用于患有严重呼吸和心脏功能不全的患者。体外膜肺氧合器已应用于8例患者，对这些患者药物治疗和主动脉内球囊反搏均无效。不幸的是，105天后只有1例患者成功脱离体外膜肺氧合器，同时维持了良好的血流动力学。心脏辅助的第三种方法是使用柏林人工心脏心室。从1999年到2003年，15个柏林人工心脏心室已连接到13例患者，其中7例作为心脏移植的桥梁。其中1例患者已存活超过2年，6例患者进行了心脏移植。有8例心脏切开术后患者植入了柏林人工心脏心室。在主动脉内球囊反搏的使用方面积累了最多经验。53%的患者经此类治疗后出院这一事实表明了其有效性。我们在体外膜肺氧合器的应用方面经验很少，因此难以得出结论。而柏林人工心脏心室的应用是一种有效的辅助循环方法（心脏辅助），是心脏移植的桥梁且在长期治疗中有效。
