Haj-Yahia Saleem, Birks Emma J, Rogers Paula, Bowles Christopher, Hipkins Mandy, George Robert, Amrani Mohammed, Petrou Mario, Pepper John, Dreyfus Gilles, Khaghani Asghar
Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield Hospital, London, UK.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):199-203. doi: 10.1016/j.jtcvs.2007.01.002.
Rotary axial flow pumps have several potential advantages and disadvantages over pulsatile pumps. The Jarvik 2000 is distinctive in being intracardiac. We report our experience in 22 patients.
The Jarvik 2000 was implanted in 15 men and 7 women. Mean age was 38.8 (range 23-59) years, preoperative diagnosis was dilated cardiomyopathy in 16, postpartum cardiomyopathy in 3, ischemic heart disease in 2, and chronic allograft failure in 1. Twenty-one patients were in New York Heart Association class IV, and 1 patient was in class III. Nineteen patients were on inotropic support, 6 were supported with an intra-aortic balloon pump, and 2 patients had been salvaged with a Centrimag (Levitronix) ventricular assist device. The median pulmonary vascular resistance was 3 Wood units; median pulmonary capillary wedge pressure was 26.6 mm Hg; and mean Cardiac Index was 1.5 L/min/m2.
There were 2 early deaths and 6 late deaths. The average postoperative ventilation time and Intensive Treatment Unit stay was 2.2 and 10 days, respectively. One patient required a right ventricular assist device for short-term support and another for medium-term support. Seven patients were bridged to transplant, 3 had myocardial recovery, and 4 are ongoing. Mean and total duration of support was 280.5 and 6172 days, respectively. Driveline failures were noted in 3, but there were no pump infections or failure.
The Jarvik 2000 provides satisfactory intermediate-term results as a bridge to transplant or recovery. It appears to be associated with a low rate of serious driveline or pump infections and technical failure. However, bleeding complications due to the required anticoagulation treatment frequently occurred.
与搏动泵相比，旋转轴流泵有若干潜在的优缺点。Jarvik 2000的独特之处在于其为心内植入式。我们报告22例患者的使用经验。
将Jarvik 2000植入15例男性和7例女性患者体内。平均年龄为38.8岁（范围23 - 59岁），术前诊断为扩张型心肌病16例，产后心肌病3例，缺血性心脏病2例，慢性移植物功能衰竭1例。21例患者为纽约心脏协会IV级，1例为III级。19例患者接受了正性肌力药物支持，6例使用主动脉内球囊泵支持，2例患者曾使用Centrimag（Levitronix）心室辅助装置抢救成功。肺血管阻力中位数为3伍德单位；肺毛细血管楔压中位数为26.6 mmHg；平均心脏指数为1.5 L/min/m²。
有2例早期死亡和6例晚期死亡。术后平均通气时间和重症监护病房停留时间分别为2.2天和10天。1例患者需要短期使用右心室辅助装置，另1例需要中期使用。7例患者过渡到移植，3例心肌恢复，4例仍在治疗中。平均支持时间和总支持时间分别为280.5天和6172天。发现3例发生驱动线故障，但无泵感染或故障。
Jarvik 2000作为移植或恢复的桥梁，提供了令人满意的中期结果。它似乎与严重的驱动线或泵感染及技术故障发生率较低相关。然而，由于所需的抗凝治疗，出血并发症频繁发生。
