Haft Jonathan W, Suzuki Yoshi, Aaronson Keith D, Dyke David B, Wright Susan, Poirier Victor L, Pagani Francis D
Section of Cardiac Surgery, University of Michigan Health Systems, Ann Arbor, Michigan, USA.
ASAIO J. 2007 May-Jun;53(3):298-303. doi: 10.1097/MAT.0b013e318033a6b0.
Predicting end-of-life for left ventricular assist devices is important to determine timing of device removal. A retrospective analysis was performed on 46 patients undergoing implantation of the latest HeartMate XVE from July 1, 2003, through March 31, 2006. Devices were assessed by analysis of motor current waveforms and quantification of the titanium or copper particles within dust localized to the driveline vent filter by optical, polarized light, scanning electron microscopy, and energy dispersive x-ray spectroscopy. Assessments were performed monthly for patients supported > or =330 days or for unexpected device alarms. Thirty-one (67%) patients were supported for <330 days and 15 (33%) were supported for > or =330 days. No malfunctions occurred in patients supported <330 days. For patients supported > or =330 days, five had abnormal current waveforms or copper and titanium dust localized to the vent filter. One underwent urgent transplantation, three underwent device replacement (one death; two ongoing), and one is with ongoing support. Of the remaining 10 patients, seven underwent transplantation; two remain on device; and one died while on left ventricular assist device support. There were no unexpected device failures. Bearing wear of the HeartMate XVE is predictable by analysis of current waveforms or titanium and copper dust within the vent filter.
预测左心室辅助装置的使用寿命对于确定装置移除时机至关重要。对2003年7月1日至2006年3月31日期间接受最新款HeartMate XVE植入手术的46例患者进行了回顾性分析。通过分析电机电流波形以及采用光学显微镜、偏振光显微镜、扫描电子显微镜和能量色散X射线光谱法对位于驱动线排气过滤器内灰尘中的钛或铜颗粒进行定量分析，来评估装置情况。对于支持时间≥330天的患者或出现意外装置警报的患者，每月进行一次评估。31例（67%）患者的支持时间<330天，15例（33%）患者的支持时间≥330天。支持时间<330天的患者未发生故障。对于支持时间≥330天的患者，5例出现异常电流波形或排气过滤器处有铜和钛灰尘。1例接受了紧急移植，3例进行了装置更换（1例死亡；2例仍在进行中），1例仍在接受支持治疗。在其余10例患者中，7例接受了移植；2例仍使用装置；1例在左心室辅助装置支持下死亡。未出现意外的装置故障。通过分析电流波形或排气过滤器内的钛和铜灰尘，可以预测HeartMate XVE的轴承磨损情况。
