Brinkman William T, Rosenthal Jed E, Eichhorn Eric, Dewey Todd M, Magee Mitchell J, Savor Darinka S, Riley Angela G, Prince Syma L, Worley Christine M, Herbert Morley A, Mack Michael J
Medical City Dallas Hospital, Dallas, Texas 75230, USA.
Ann Thorac Surg. 2009 Nov;88(5):1462-6. doi: 10.1016/j.athoracsur.2009.07.015.
The role of a percutaneous ventricular assist device (VAD) for left heart support in the management of patients in cardiogenic shock is not well defined.
All patients who received LV support using the percutaneous TandemHeart (percTH) ventricular support device (Cardiac Assist, Pittsburgh, PA) were retrospectively reviewed. Indications for insertion included bridge to decision (BTD) or "salvage" and bridge to transplant (BTT).
Between April 2005 and December 2008, 22 percTH devices were successfully implanted in patients (13 men) with isolated left heart failure. Mean duration of support was 6.8 +/- 9.4 days (median, 4; maximum, 45 days). Of patients requiring percTH support for at least 3 days, mean pump flows were 3.77 +/- 1.10, 4.22 +/- 0.69, and 4.04 +/- 0.41 L/min on at days 1, 2, and 3. Mean serum aspartate aminotransferase levels were 455 +/- 994 mg/dL before percTH, 551 +/- 1046 mg/dL at day 1, and 231 +/- 225 mg/dL at day 3 after percTH. No mechanical device failure, device-related infections, or cerebrovascular accidents occurred. Ten of 11 BTT patients were successfully bridged. Support was withdrawn in 7 of 11 BTD patients. The percTHs were successfully explanted in 4 BTD patients: 1 as recovery, 1 direct to transplant, and 2 to VAD.
The percTH was reliable, with no mechanical device failures and minimal associated adverse events. We support the use of the percTH in the BTD mode, allowing time for a more complete evaluation of neurologic and end-organ status without the added expense and morbidity of a long-term VAD.
经皮心室辅助装置（VAD）在心源性休克患者管理中用于左心支持的作用尚不明确。
对所有使用经皮串联式人工心脏（percTH）心室辅助装置（心脏辅助公司，匹兹堡，宾夕法尼亚州）接受左心支持的患者进行回顾性研究。植入指征包括过渡到决策（BTD）或“挽救”以及过渡到移植（BTT）。
2005年4月至2008年12月期间，22例percTH装置成功植入孤立性左心衰竭患者（13例男性）体内。平均支持时间为6.8±9.4天（中位数为4天；最长为45天）。在至少需要percTH支持3天的患者中，第1天、第2天和第3天的平均泵流量分别为3.77±1.10、4.22±0.69和4.04±0.41升/分钟。percTH植入前平均血清天冬氨酸转氨酶水平为455±994毫克/分升，第1天为551±1046毫克/分升，percTH植入后第3天为231±225毫克/分升。未发生机械装置故障、与装置相关的感染或脑血管意外。11例BTT患者中有10例成功过渡。11例BTD患者中有7例停止支持。4例BTD患者的percTH成功取出：1例恢复，1例直接移植，2例更换为VAD。
percTH可靠，无机械装置故障且相关不良事件极少。我们支持在BTD模式下使用percTH，以便有时间更全面地评估神经和终末器官状态，而无需长期VAD带来的额外费用和发病率。
