Saito Shunsuke, Matsumiya Goro, Sakaguchi Taichi, Fujita Tomoyuki, Kuratani Toru, Ichikawa Hajime, Sawa Yoshiki
Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Japan.
J Artif Organs. 2009;12(1):27-34. doi: 10.1007/s10047-009-0448-5. Epub 2009 Mar 29.
Our 15-year experience of the Toyobo paracorporeal left ventricular assist system (LVAS) at Osaka University Hospital was reviewed. In total, 61 patients underwent Toyobo LVAS implantation from January 1992 to August 2007. Their mean age was 38.1 +/- 16.9 years. The etiologies of heart failure were idiopathic dilated cardiomyopathy in 35 patients, ischemic cardiomyopathy in 15, myocarditis in 5, secondary cardiomyopathy in 4, and others in 2. Preoperatively, intubation was required in 41 patients (67.3%), an intra-aortic balloon pump was required in 38 (62.3%), and extracorporeal membrane oxygenation was required in 30 (49.2%). Four patients underwent heart transplantation and 11 underwent LVAS removal. Of those 11 patients, 4 were subjected to emergent removal because of device complications and all of them died. Of the 7 patients that underwent scheduled LVAS removal, heart failure recurred in 2 patients and reimplantation was required. In terms of major device-related complications, cerebral hemorrhage occurred in 16 patients (26.2%), cerebral infarction in 19 (31.1%), mediastinitis in 10 (16.4%), and inflow/outflow cannula exit site infection in 19 patients (31.1%). The actuarial survival rate of the patients operated on in the last 5 years of this study was 66.3% at 6 months and 45.9% at 1 year. Although the survival rate of patients supported by the Toyobo LVAS has recently improved, the morbidity rate is significant. Considering the current severe shortage of heart donors in Japan, it is important to introduce more durable devices with fewer complications and to establish the strategies for using the LVAS as a bridge to recovery.
我们回顾了大阪大学医院使用东洋纺体外左心室辅助系统(LVAS)的15年经验。1992年1月至2007年8月期间,共有61例患者接受了东洋纺LVAS植入术。他们的平均年龄为38.1±16.9岁。心力衰竭的病因包括特发性扩张型心肌病35例、缺血性心肌病15例、心肌炎5例、继发性心肌病4例、其他2例。术前,41例患者(67.3%)需要插管,38例(62.3%)需要主动脉内球囊泵,30例(49.2%)需要体外膜肺氧合。4例患者接受了心脏移植,11例患者移除了LVAS。在这11例患者中,4例因装置并发症而紧急移除,全部死亡。在7例计划移除LVAS的患者中,2例患者心力衰竭复发,需要再次植入。在主要的与装置相关的并发症方面,16例患者(26.2%)发生脑出血,19例(31.1%)发生脑梗死,10例(16.4%)发生纵隔炎,19例患者(31.1%)发生流入/流出插管出口部位感染。本研究最后5年接受手术的患者的精算生存率在6个月时为66.3%,在1年时为45.9%。尽管最近使用东洋纺LVAS支持的患者的生存率有所提高,但发病率仍然很高。考虑到日本目前心脏供体严重短缺的情况,引入更耐用、并发症更少的装置并制定将LVAS用作恢复桥梁的策略非常重要。