Wilhelm Markus J, Hammel Dieter, Schmid Christof, Rhode Andreas, Kaan Timo, Rothenburger Markus, Stypmann Jörg, Schäfers Michael, Schmidt Christoph, Baba Hideo A, Scheld Hans H
Department of Thoracic and Cardiovascular Surgery, Westfalian Wilhelms-University, Muenster, Germany.
J Thorac Cardiovasc Surg. 2005 Oct;130(4):1122-9. doi: 10.1016/j.jtcvs.2004.10.029.
Pulsatile left ventricular assist devices serving as mechanical circulatory support for patients with end-stage heart failure are associated with complications, including bleeding, thromboembolism, and infection. Axial-flow pumps might overcome some of these shortcomings. Here we report our experience with long-term application of the DeBakey VAD (MicroMed Technology, Inc, Houston, Tex).
Nine male transplant candidates (37 +/- 14 years) with severe hemodynamic compromise (cardiac index, 1.6 +/- 0.5 L . min(-1) x m(-2); pulmonary capillary wedge pressure, 27 +/- 6 mm Hg) and beginning end-organ failure despite inotropic and intra-aortic balloon pump support received the DeBakey VAD. Clinical outcome was evaluated.
Cumulative support was 7.8 years, and the mean duration of support was 314 +/- 75 days (range, 229-438 days). Eight patients were transplanted, and one died from intracerebral bleeding. Peripheral circulation and end-organ function recovered rapidly after implantation. Continuous flow was able to maintain adequate organ perfusion over the long term. Eight patients were discharged during support, with good quality of life. There were no early bleedings, but there were late bleedings in 3 patients caused by excessive anticoagulation and platelet inhibition. Neurologic events occurred in 4 patients. Three patients recovered completely from symptoms, and one had lethal intracerebral bleeding. Because of thrombus formation, the device was exchanged in 4 patients. With increasing experience, thrombolysis was performed in similar situations. All such patients underwent successful transplantation. Hemolysis occurred, with events indicating thrombus formation. Device-related infection was found in one patient.
The DeBakey VAD demonstrated its potential for long-term bridge to transplantation. The risk for thrombus formation needs to be addressed by improvement of pump technology and new strategies for platelet inhibition.
作为终末期心力衰竭患者机械循环支持的搏动性左心室辅助装置与并发症相关，包括出血、血栓栓塞和感染。轴流泵可能会克服其中一些缺点。在此，我们报告我们长期应用德巴基心室辅助装置（DeBakey VAD，MicroMed Technology公司，得克萨斯州休斯顿）的经验。
9名男性心脏移植候选者（37±14岁），尽管接受了正性肌力药物和主动脉内球囊泵支持，但仍有严重的血流动力学损害（心脏指数，1.6±0.5L·min⁻¹·m⁻²；肺毛细血管楔压，27±6mmHg）且开始出现终末器官功能衰竭，接受了德巴基心室辅助装置治疗。对临床结局进行评估。
累计支持时间为7.8年，平均支持时间为314±75天（范围，229 - 438天）。8名患者接受了移植，1名患者死于脑出血。植入后外周循环和终末器官功能迅速恢复。持续血流能够长期维持足够的器官灌注。8名患者在支持治疗期间出院，生活质量良好。无早期出血，但3名患者因抗凝过度和血小板抑制导致晚期出血。4名患者发生神经系统事件。3名患者症状完全恢复，1名患者发生致命性脑出血。因血栓形成，4名患者更换了装置。随着经验增加，在类似情况下进行了溶栓治疗。所有这些患者均成功接受了移植。发生了溶血，有事件提示血栓形成。1名患者发现与装置相关的感染。
德巴基心室辅助装置显示出其作为长期移植桥梁的潜力。血栓形成风险需要通过改进泵技术和新的血小板抑制策略来解决。
