Busch Jonas, Torre-Amione Guillermo, Noon George P, Loebe Matthias
Department of Surgery, Methodist DeBakey Heart Center, Baylor College of Medicine, Houston, Texas 77030, USA.
Tex Heart Inst J. 2008;35(4):462-5.
The TandemHeart percutaneous ventricular assist device (pVAD), which provides temporary circulatory support of the left ventricle, can be used in high-risk and hemodynamically unstable patients. The easily inserted TandemHeart provides cardiac support superior to that from the use of intra-aortic balloon pumps. Herein, we discuss TandemHeart implantation via end-to-side femoral arterial grafting in a cardiac patient whose sepsis and multiorgan failure were complicated by coagulopathy and thromboembolism. A 47-year-old woman, on intra-aortic balloon and intravenous inotropic support after an acute myocardial infarction and emergency coronary artery bypass grafting, was transferred to our institution via helicopter. She developed sepsis and multiorgan failure. Her condition was further complicated by coagulopathy and a left-lower-extremity thromboembolism. After 6 weeks of aggressive pharmacologic and intermittent intra-aortic balloon treatment, the patient developed cardiogenic shock and received a TandemHeart pVAD for short-term circulatory support. A GORE-TEX access graft, sewn end-to-side to the femoral artery because of the patient's leg ischemia and very small vessels, served as a conduit for the TandemHeart's femoral arterial inflow cannula. Her difficult circulatory, anatomic, and coagulopathic status stabilized after 2 weeks of TandemHeart support, and she was bridged to the long-term MicroMed DeBakey VAD Child in anticipation of heart transplantation. The case of our patient shows that high-risk patients who have experienced cardiogenic shock with multiorgan failure and coagulopathy can benefit from the TandemHeart pVAD as a bridge to other therapeutic options, even when creative approaches to treatment and to TandemHeart insertion are required.
串联式人工心脏经皮心室辅助装置（pVAD）可对左心室提供临时循环支持，适用于高危和血流动力学不稳定的患者。易于插入的串联式人工心脏提供的心脏支持优于主动脉内球囊泵。在此，我们讨论通过端侧股动脉移植植入串联式人工心脏的情况，该患者为一名心脏病患者，其败血症和多器官功能衰竭并发凝血病和血栓栓塞。一名47岁女性，在急性心肌梗死和急诊冠状动脉搭桥术后接受主动脉内球囊和静脉注射强心药物支持，通过直升机转至我院。她出现了败血症和多器官功能衰竭。她的病情因凝血病和左下肢血栓栓塞而进一步复杂化。经过6周积极的药物治疗和间歇性主动脉内球囊治疗后，患者发生心源性休克，接受了串联式人工心脏pVAD进行短期循环支持。由于患者腿部缺血且血管非常细小，将一段戈尔特斯（GORE-TEX）血管移植物端侧缝合至股动脉，作为串联式人工心脏股动脉流入插管的导管。在串联式人工心脏支持2周后，她复杂的循环、解剖和凝血病状态得以稳定，在等待心脏移植期间，她被过渡到长期使用的美敦力德巴基儿童型心室辅助装置（MicroMed DeBakey VAD Child）。我们患者的病例表明，经历心源性休克合并多器官功能衰竭和凝血病的高危患者，即使需要采用创造性的治疗方法和串联式人工心脏植入方法，也可受益于串联式人工心脏pVAD，作为通向其他治疗选择的桥梁。
