Posch Maximillian G, Thompson Larry O, Koerner Michael M, Akay Mehmet H, Noon George P, Loebe Matthias
Michael E. DeBakey Department of Surgery, Division of Transplant Surgery and Assist Devices, Baylor College of Medicine, Houston, Texas 77030, USA.
Tex Heart Inst J. 2004;31(4):404-8.
The use of ventricular assist devices as a bridge to transplantation has become a widely used option for patients with end-stage heart failure. In contrast to total artificial hearts, ventricular assist devices support the failing heart by bypassing one or both ventricles. In certain cases (myocardial tumors, graft failure, transplant rejection, endocarditis, intracardiac thrombus formation), however, it may be advantageous to excise the heart and replace it with an artificial device. Total artificial hearts are intracorporeal devices designed for this purpose. Unfortunately, some patients are too small or are, for other reasons, ineligible for a total artificial heart. We describe the case of a 55-year-old woman who had ischemic cardiomyopathy and thrombus formation in all 4 cardiac chambers. To reduce the risk of thromboembolic events, we elected to replace her heart completely with 2 extracorporeal ventricular assist devices. The heart was excised via a median stemotomy approach, and the outflow cannulae (from device to patient) were connected to both atrial remnants. The 2 inflow cannulae (from patient to device) were anastomosed end-to-end to the aorta and the pulmonary artery, respectively. After attaining a flow of more than 5 L, the 2 extracorporeal assist devices effectively and efficiently performed the work of the native heart. Thus re-established, organ perfusion was improved by this mechanically driven circulation, as signified by an initial decrease in creatinine and blood urea nitrogen levels. The patient, however, did not recover from postoperative neurological dysfunction and died of respiratory insufficiency and multiple-organ failure on the 26th postoperative day.
心室辅助装置作为心脏移植的桥梁已成为终末期心力衰竭患者广泛采用的选择。与全人工心脏不同，心室辅助装置通过绕过一个或两个心室来支持衰竭的心脏。然而，在某些情况下（心肌肿瘤、移植物衰竭、移植排斥、心内膜炎、心内血栓形成），切除心脏并用人工装置替代可能更具优势。全人工心脏就是为此目的设计的体内装置。不幸的是，一些患者体型过小或因其他原因不符合使用全人工心脏的条件。我们描述了一名55岁女性的病例，她患有缺血性心肌病且四个心腔均有血栓形成。为降低血栓栓塞事件的风险，我们选择用两个体外心室辅助装置完全替代她的心脏。通过正中胸骨切开术切除心脏，流出插管（从装置到患者）连接至两个心房残端。两根流入插管（从患者到装置）分别与主动脉和肺动脉进行端端吻合。在流量达到5升以上后，这两个体外辅助装置有效且高效地承担了天然心脏的工作。通过这种机械驱动的循环，器官灌注得以改善，这表现为肌酐和血尿素氮水平最初下降。然而，患者术后神经功能障碍未恢复，术后第26天死于呼吸功能不全和多器官衰竭。
