Center for Cardiac Support, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA.
Ann Thorac Surg. 2009 Dec;88(6):1822-6. doi: 10.1016/j.athoracsur.2009.08.002.
We analyzed our use of the TandemHeart Percutaneous Ventricular Assist Device (Cardiac Assist Inc, Pittsburgh, PA) as a rescue therapy for patients with cardiac arrest or severe refractory cardiogenic shock (SRCS) before or after aortic valve replacement (AVR) for critical aortic valve stenosis.
We reviewed the records of 10 patients (6 men; 4 women), aged 62 +/- 12 years, who presented with cardiac arrest or SRCS. Eight patients, 5 undergoing cardiopulmonary resuscitation (CPR) and 3 with SRCS, received TandemHeart support in the catheterization laboratory and had AVR after undergoing hemodynamic stabilization. The other 2 patients went directly to the operating room while undergoing CPR, for emergency AVR and received the device for postcardiotomy cardiogenic shock. All 10 patients were intubated, on maximal vasopressor support, and 7 had an intraaortic balloon pump. The preoperative Society of Thoracic Surgeons mortality risk was 74.9% +/- 24.5%.
The 8 patients who received the TandemHeart in the catheterization laboratory were supported for 6.4 +/- 3.8 days and had significantly improved renal function before AVR. One patient died of sepsis 34 days after AVR, The other 7 were discharged home (ejection fraction, 0.42 +/- 0.14) and were alive 2 to 43 months later. The 2 patients who received the device in the operating room after AVR died on days 8 and 21, respectively.
Prompt placement of the TandemHeart in these critically ill patients yields the shortest "emergency department door to left ventricular unloading time," improves end-organ function, and allows AVR to be performed electively.
我们分析了使用 TandemHeart 经皮心室辅助装置（Cardiac Assist Inc，匹兹堡，宾夕法尼亚州）作为主动脉瓣置换术（AVR）前或后因严重主动脉瓣狭窄而心脏骤停或严重难治性心源性休克（SRCS）患者的抢救治疗。
我们回顾了 10 名患者（6 名男性；4 名女性）的记录，年龄 62±12 岁，表现为心脏骤停或 SRCS。8 名患者（5 名接受心肺复苏（CPR），3 名 SRCS）在导管室接受 TandemHeart 支持，并在血流动力学稳定后接受 AVR。另外 2 名患者在接受 CPR 时直接进入手术室，进行紧急 AVR 并接受该设备用于心脏手术后心源性休克。所有 10 名患者均进行气管插管，接受最大剂量血管加压药支持，7 名患者使用主动脉内球囊泵。术前胸外科医师协会死亡率风险为 74.9%±24.5%。
在导管室接受 TandemHeart 支持的 8 名患者支持 6.4±3.8 天，AVR 前肾功能显著改善。1 名患者在 AVR 后 34 天死于败血症，其他 7 名患者出院回家（射血分数，0.42±0.14），2 至 43 个月后仍然存活。在 AVR 后在手术室接受该设备的 2 名患者分别在第 8 天和第 21 天死亡。
在这些危重症患者中及时放置 TandemHeart 可获得最短的“急诊室到左心室卸载时间”，改善终末器官功能，并可选择性进行 AVR。
