El-Hamamsy Ismaïl, Jacques Frédéric, Perrault Louis P, Bouchard Denis, Demers Pphilippe, White Michel, Pelletier Guy B, Racine Normand, Pellerin Michel, Carrier Michel
Department of Cardiac Surgery, Montreal Heart Institute and Université de Montréal, Montreal, Quebec.
Can J Cardiol. 2009 Feb;25(2):107-10. doi: 10.1016/s0828-282x(09)70478-7.
Mechanical circulatory support systems (MCSS) have been available in Canada since 1986. Accepted indications include bridging to transplantation or recovery. The present study reviewed the results following MCSS implantation at the Montreal Heart Institute (Montreal, Quebec).
From September 1987 to September 2006, 43 MCSS were implanted (32 Thoratec [Thoratec Corporation, USA], nine CardioWest TAH [SynCardia Systems Inc, USA], two Novacor [WorldHeart Corporation, Canada]) in 43 patients (mean [+/- SD] age 44+/-13 years; range 19 to 64 years). Indications for implantation included cardiogenic shock due to ischemic (n=19), viral (n=10) or other types of cardiomyopathies (n=14).
The mean ejection fraction before implantation was 17.6+/-6.5% (range 10% to 45%). Before MCSS implantation, most patients showed signs of end-organ failure, including mechanical ventilation (77%), central venous pressure higher than 16 mmHg (44%), oliguria (35%) and hepatic dysfunction (19%). The mean duration of MCSS support was 22.8+/-32.8 days (range one to 158 days). Survival to transplantation or recovery was 74%. Only one patient was successfully bridged to recovery. Complications were common during MCSS support. They included reexploration for bleeding (47%), respiratory failure (44%), renal failure requiring temporary dialysis (40%), infection (33%) and neurological events (16%). Only one patient had device failure. In patients successfully bridged to transplantation, early actuarial survival (one month) following transplantation averaged 71+/-8% and was 57+/-9% at one year.
MCSS support with a left ventricular assist device or a total artificial heart provides an effective means of bridging terminally ill patients to transplantation or recovery. Early survival after transplantation shows satisfactory results. However, these results come at the expense of frequent device-related complications, and device failure remains a constant threat.
自1986年起，加拿大便已应用机械循环支持系统（MCSS）。其公认的适应证包括过渡到移植或恢复。本研究回顾了蒙特利尔心脏研究所（魁北克省蒙特利尔）植入MCSS后的结果。
从1987年9月至2006年9月，43例患者植入了43套MCSS（32套Thoratec [美国Thoratec公司]，9套CardioWest全人工心脏[美国SynCardia系统公司]，2套Novacor [加拿大世界心脏公司]），患者平均年龄（±标准差）为44±13岁（范围19至64岁）。植入适应证包括缺血性（n = 19）、病毒性（n = 10）或其他类型心肌病（n = 14）所致的心源性休克。
植入前平均射血分数为17.6±6.5%（范围10%至45%）。在植入MCSS前，大多数患者出现终末器官功能衰竭的体征，包括机械通气（77%）、中心静脉压高于16 mmHg（44%）、少尿（35%）和肝功能障碍（19%）。MCSS支持的平均持续时间为22.8±32.8天（范围1至158天）。移植或恢复后的生存率为74%。只有1例患者成功过渡到恢复。在MCSS支持期间并发症很常见。包括因出血再次手术（47%）、呼吸衰竭（44%）、需要临时透析的肾衰竭（40%）、感染（33%）和神经系统事件（16%）。只有1例患者出现设备故障。在成功过渡到移植的患者中，移植后早期精算生存率（1个月）平均为71±8%，1年时为57±9%。
使用左心室辅助装置或全人工心脏的MCSS支持为将重症患者过渡到移植或恢复提供了一种有效手段。移植后的早期生存率显示出令人满意的结果。然而，这些结果是以频繁出现与设备相关的并发症为代价的，并且设备故障仍然是一个持续存在的威胁。
