Bruckner Brian A, Jacob Leon P, Gregoric Igor D, Loyalka Pranav, Kar Biswajit, Cohn William E, La Francesca Saverio, Radovancevic Branislav, Frazier O H
Department of Cardiovascular Surgery, The Methodist Hospital, Houston, Texas 77030, USA.
Tex Heart Inst J. 2008;35(4):447-50.
Cardiac support with a ventricular assist device is among the few treatments for heart-failure patients who have profound cardiogenic shock unresponsive to vasopressors and intra-aortic balloon pumps. The TandemHeart percutaneous ventricular assist device can provide temporary support until another device can be placed or a donor heart becomes available. We examined the TandemHeart's effect on cardiac index, central venous pressure, mixed venous oxygen saturation, creatinine, mean arterial pressure, urine output, and 30-day mortality rate in 5 heart-failure patients (2 with nonischemic and 3 with ischemic cardiomyopathy; mean preoperative left ventricular ejection fraction, 0.17 +/- 0.056). Two patients were undergoing cardiopulmonary resuscitation when the device was inserted. The average duration of TandemHeart support was 7.6 +/- 3.2 days; all patients were successfully bridged to transplantation. The TandemHeart improved the cardiac index (1.9 +/- 0.3 vs 3.5 +/- 0.8 L/[min.m2], P= 0.01), mean arterial pressure (69 +/- 12.5 vs 91 +/- 4.3 mmHg, P=0.009), mixed venous oxygen saturation (45.4 +/- 14.3 vs 71.4 +/- 7.5, P=0.009), and urine output (1,861 +/- 988 vs 4,314 +/- 1,346 mL/hr, P=0.01). The device decreased central venous pressure (21.2 +/- 7.4 vs 12.8 +/- 5.9 mmHg, P=0.02) and pressor requirements (2.4 +/- 1.1 vs 1.0 +/- 0.7 agents, P=0.02). Average long-term follow-up after heart transplantation was 8.4 +/- 9.9 months, with no deaths. We conclude that the TandemHeart can provide hemodynamic support for patients with profound, refractory cardiogenic shock. Furthermore, the device can bridge patients to cardiac transplantation and can be placed percutaneously, without invasive surgery.
对于那些患有严重心源性休克且对血管加压药和主动脉内球囊泵无反应的心力衰竭患者，使用心室辅助装置进行心脏支持是为数不多的治疗方法之一。TandemHeart经皮心室辅助装置可以提供临时支持，直到能够植入另一种装置或获得供体心脏。我们研究了TandemHeart对5例心力衰竭患者（2例非缺血性心肌病和3例缺血性心肌病；术前平均左心室射血分数为0.17±0.056）的心脏指数、中心静脉压、混合静脉血氧饱和度、肌酐、平均动脉压、尿量和30天死亡率的影响。两名患者在插入该装置时正在进行心肺复苏。TandemHeart支持的平均持续时间为7.6±3.2天；所有患者均成功过渡到移植手术。TandemHeart改善了心脏指数（1.9±0.3对比3.5±0.8L/[min·m2]，P = 0.01）、平均动脉压（69±12.5对比91±4.3mmHg，P = 0.009）、混合静脉血氧饱和度（45.4±14.3对比71.4±7.5，P = 0.009）和尿量（1861±988对比4314±1346mL/小时，P = 0.01）。该装置降低了中心静脉压（21.2±7.4对比12.8±5.9mmHg，P = 0.02）和血管加压药需求（2.4±1.1对比1.0±0.7种药物，P = 0.02）。心脏移植后的平均长期随访时间为8.4±9.9个月，无死亡病例。我们得出结论，TandemHeart可以为患有严重难治性心源性休克的患者提供血流动力学支持。此外，该装置可以使患者过渡到心脏移植，并且可以经皮放置，无需进行侵入性手术。
