Kirsch Matthias, Vermes Emmanuelle, Damy Thibaud, Nakashima Kuniki, Sénéchal Mélanie, Boval Bernadette, Drouet Ludovic, Loisance Daniel
Service de chirurgie thoracique et cardiovasculaire, hôpital Henri-Mondor, AP-HP, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94000 Créteil cedex, France.
Arch Cardiovasc Dis. 2009 Jun-Jul;102(6-7):509-18. doi: 10.1016/j.acvd.2009.03.010. Epub 2009 May 23.
Temporary mechanical circulatory support may be indicated in some patients with cardiac failure refractory to conventional therapy, as a bridge to myocardial recovery or transplantation.
To evaluate outcomes in cardiogenic shock patients managed by the primary use of a paracorporeal ventricular assist device (p-VAD).
We did a retrospective analysis of demographics, clinical characteristics and survival of patients assisted with a Thoratec p-VAD.
p-VADs were used in 84 patients with cardiogenic shock secondary to acute myocardial infarction (35%), idiopathic (31%) or ischaemic (12%) cardiomyopathy, myocarditis or other causes (23%). Before implantation, 23% had cardiac arrest, 38% were on a ventilator and 31% were on an intra-aortic balloon pump. Cardiac index was 1.6+/-0.5 L/min/m(2) and total bilirubin levels were 39+/-59 micromol/L. During support, 29 patients (35%) died in the intensive care unit and seven (10%) died after leaving. Forty-seven patients (56%) were weaned or transplanted, with one still under support. Despite significantly more advanced preoperative end-organ dysfunction, survival rates were similar in patients with biventricular devices (74%) and those undergoing isolated left ventricular support (24%) (63% versus 45%, respectively; p=0.2). Actuarial survival estimates after transplantation were 78.7+/-6.3%, 73.4+/-6.9% and 62.6+/-8.3% at 1, 3 and 5 years, respectively.
Our experience validates the use of p-VAD as a primary device to support patients with cardiogenic shock. In contrast to short-term devices, p-VADs provide immediate ventricular unloading and pulsatile perfusion in a single procedure. Biventricular support should be used liberally in patients with end-organ dysfunction.
对于一些常规治疗难以奏效的心力衰竭患者，可采用临时机械循环支持，作为心肌恢复或移植的桥梁。
评估主要使用体外心室辅助装置（p-VAD）治疗的心源性休克患者的预后。
我们对使用Thoratec p-VAD辅助治疗的患者的人口统计学、临床特征和生存率进行了回顾性分析。
84例心源性休克患者使用了p-VAD，病因包括急性心肌梗死（35%）、特发性（31%）或缺血性（12%）心肌病、心肌炎或其他原因（23%）。植入前，23%的患者发生心脏骤停，38%的患者使用呼吸机，31%的患者使用主动脉内球囊泵。心脏指数为1.6±0.5 L/min/m²，总胆红素水平为39±59 μmol/L。在支持治疗期间，29例患者（35%）在重症监护病房死亡，7例患者（10%）出院后死亡。47例患者（56%）撤机或接受移植，1例仍在接受支持治疗。尽管术前终末器官功能障碍更为严重，但双心室装置患者（74%）和接受单纯左心室支持患者（24%）的生存率相似（分别为63%和45%；p=0.2）。移植后的精算生存率估计在第1、3和5年分别为78.7±6.3%、73.4±6.9%和62.6±8.3%。
我们的经验证实了p-VAD作为支持心源性休克患者的主要装置的应用。与短期装置不同，p-VAD可在单一手术中立即实现心室卸载和搏动灌注。对于终末器官功能障碍的患者，应广泛使用双心室支持。
