Transplant Unit, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):466-73. doi: 10.1016/j.jtcvs.2009.07.058. Epub 2009 Oct 14.
The Thoratec (Thoratec Corp, Pleasanton, Calif) implantable ventricular assist device (IVAD) can be used for univentricular or biventricular support. The objective of this study is to review the 5-year experience of bridging patients to heart transplantation with this device in a single center. Surgical aspects, including hybrid pump pocket, double tunneling of driveline, and optimal cannulae placement, are discussed.
This is a retrospective review of 24 patients treated between January 2002 and December 2007. Nineteen patients (79.1%) received a single implantable ventricular assist device as left ventricular assist devices, and 5 patients (21.9%) received 2 implantable ventricular assist devices as biventricular assist devices. The devices were implanted in pre-peritoneal/posterior rectus hybrid pump pockets. The driveline was passed through a 2-stage double-tunnel to exit onto the lateral chest wall. Patients were anticoagulated with Warfarin aiming for an international normalized ratio of 2.0 to 3.0.
Twenty male and 4 female patients with a mean age of 39.8 years (17-57 years) and a body surface area of 1.87 m(2) (1.63-2.2 m(2)) were supported for a total of 2308 patient-days. Mean duration of support was 96 days (10-301 days). The cause of heart failure was dilated cardiomyopathy in 18 patients and ischemic cardiomyopathy in 6 patients. Preoperatively, 23 patients were receiving inotropes, 12 patients required intra-aortic balloon pump support, 5 patients were intubated and mechanically ventilated, and 3 patients required continuous venovenous hemofiltration for renal support. Eleven patients (45.8%) were discharged with ventricular assist device support (1015 home patient-days). Complications observed were a) neurologic: stroke in 3 patients, transient ischemic attacks in 4 patients; and b) infection: driveline infection in 3 patients and pump pocket infection in 1 patient. There was no mechanical device failure. Support to transplantation was achieved in 17 patients (70.8%): 3 of 5 biventricular assist devices (60%) and 14 of 19 left ventricular assist devices (73.7%).
The Thoratec IVAD is a versatile and reliable ventricular assist device. It can provide univentricular or biventricular support for bridging patients to heart transplantation with acceptable complication rates. The portable Thoratec TLC-II console facilitated discharge while patients waited for a suitable donor heart.
Thoratec（Thoratec 公司，加利福尼亚州普莱森顿）植入式心室辅助装置（IVAD）可用于单心室或双心室支持。本研究的目的是回顾单中心使用该装置桥接患者进行心脏移植的 5 年经验。讨论了手术方面，包括杂交泵袋、驱动轴的双隧道和最佳插管位置。
这是对 2002 年 1 月至 2007 年 12 月期间接受治疗的 24 例患者的回顾性分析。19 例患者（79.1%）接受了单植入式心室辅助装置作为左心室辅助装置，5 例患者（21.9%）接受了 2 个植入式心室辅助装置作为双心室辅助装置。这些设备被植入在腹膜前/后直肌杂交泵袋中。驱动轴通过 2 级双隧道传递，出口到侧胸壁。患者用华法林抗凝，目标国际标准化比值为 2.0 至 3.0。
20 名男性和 4 名女性患者，平均年龄 39.8 岁（17-57 岁），体表面积 1.87m2（1.63-2.2m2），共支持 2308 患者天。平均支持时间为 96 天（10-301 天）。心力衰竭的病因是扩张型心肌病 18 例，缺血性心肌病 6 例。术前 23 例患者接受正性肌力药物治疗，12 例患者需要主动脉内球囊泵支持，5 例患者插管机械通气，3 例患者需要连续静脉-静脉血液滤过以支持肾脏。11 例（45.8%）患者在植入心室辅助装置的情况下出院（1015 天家庭患者）。观察到的并发症为：a）神经系统：3 例患者发生中风，4 例患者发生短暂性脑缺血发作；和 b）感染：3 例患者发生驱动轴感染，1 例患者发生泵袋感染。没有发生机械装置故障。17 例（70.8%）患者实现了向移植的支持：5 例双心室辅助装置中的 3 例（60%）和 19 例左心室辅助装置中的 14 例（73.7%）。
Thoratec IVAD 是一种多功能、可靠的心室辅助装置。它可以为桥接患者进行心脏移植提供单心室或双心室支持，并发症发生率可接受。便携式 Thoratec TLC-II 控制台在患者等待合适供体心脏期间，方便了患者出院。
