Garatti Andrea, Russo Claudio, Lanfranconi Marco, Colombo Tiziano, Bruschi Giuseppe, Trunfio Salvatore, Milazzo Filippo, Catena Emanuele, Colombo Paola, Maria Frigerio, Vitali Ettore
Cardiac Surgery Division, A. De Gasperis Department, Niguarda Ca'Granda Hospital, Milan, Italy.
ASAIO J. 2007 May-Jun;53(3):278-87. doi: 10.1097/MAT.0b013e318057fae3.
Cardiogenic shock (CS) occurs in 7% to 10% of cases after acute myocardial infarction and remains the most common cause of death in these patients. Despite aggressive treatment regimens such as fibrinolysis and percutaneous transluminal coronary angioplasty, mortality rates from CS remain extremely high. It has been shown that intra-aortic balloon pumping can result in initial hemodynamic stabilization. However, in the majority of studies, death was merely delayed. In recent years, efforts have been made to develop ventricular devices (LVAD) capable of providing complete short-term hemodynamic support. Seventeen major studies of LVAD support for CS complicating acute myocardial infarction are reported in the literature, with a mean weaning and survival rate of 58.5% and 40%, respectively. Patients considered in these studies are difficult to compare in terms of demographic and anatomic data, but taking these considerations into account, LVAD support seems to give no survival improvement in these patients compared with early reperfusion alone or associated with intra-aortic balloon pumping. Data emerging from experimental studies of acute myocardial infarction supported with LVAD are intriguing. In this review, we report the LVAD experience in the CS setting, starting from percutaneous extracorporeal support up to bridge therapy with implantable devices.
心源性休克（CS）发生于7%至10%的急性心肌梗死后病例中，仍是这些患者最常见的死亡原因。尽管采取了诸如溶栓和经皮冠状动脉腔内血管成形术等积极的治疗方案，但CS的死亡率仍然极高。已表明主动脉内球囊反搏可导致初始血流动力学稳定。然而，在大多数研究中，死亡只是被推迟了。近年来，人们努力开发能够提供完整短期血流动力学支持的心室装置（左心室辅助装置，LVAD）。文献报道了17项关于LVAD支持治疗并发急性心肌梗死的CS的主要研究，平均撤机率和生存率分别为58.5%和40%。这些研究中的患者在人口统计学和解剖学数据方面难以比较，但考虑到这些因素，与单独早期再灌注或与主动脉内球囊反搏联合使用相比，LVAD支持似乎并未提高这些患者的生存率。LVAD支持急性心肌梗死的实验研究中出现的数据很有趣。在本综述中，我们报告了在CS情况下LVAD的经验，从经皮体外支持到可植入装置的桥接治疗。
