Yildiz Cenk Eray, Sayin Murat, Yerebakan Halit, Kucukaksu Suha
Department of Cardiovascular Surgery, Yeditepe University Hospital, School of Medicine, Istanbul, Turkey.
Heart Surg Forum. 2010 Feb;13(1):E60-2. doi: 10.1532/HSF98.20091083.
The importance of minimally invasive cardiac operations, performed off-pump, without the support of cardiopulmonary bypass (CPB), is continuously increasing. Complete revascularization of obstructed coronary arteries is needed to obtain a better long-term outcome. Insertion into the left ventricle of an efficient microaxial pump can be useful when targeting an important coronary artery located at posterior wall of the heart in a patient with hemodynamic deficiency. The use of such a device can enable surgeons to avoid conversion from a preplanned off-pump strategy to traditional on-pump coronary bypass surgery. The Impella Microaxial Ventricular Assist Device (VAD) (Abiomed, Aachen, Germany) is a miniature pump with a 7-mm catheter and a flow rate of approximately 2.5-5 L/min. This device can enable cardiovascular surgery to be performed without damaging the left ventricle and causing serious aortic deficiency. Therefore, in patients with serious comorbidity, complete revascularization may be performed off pump, with the heart beating, because of the hemodynamic stability provided with the support of the microaxial intracardiac pump. If required, this pump can also support the heart during the early postoperative period. We report the first assisted beating-heart coronary artery bypass graft surgery performed with the Impella Microaxial VAD in our country. The surgery was performed on 2 patients considered high risk on the basis of EUROSCORE testing.
非体外循环下进行的微创心脏手术的重要性不断增加，这类手术无需心肺转流（CPB）的支持。为获得更好的长期疗效，需要对阻塞的冠状动脉进行完全血运重建。对于存在血流动力学缺陷且重要冠状动脉位于心脏后壁的患者，在左心室插入高效微型轴流泵可能会有所帮助。使用这种装置可使外科医生避免将预先计划的非体外循环策略转换为传统的体外循环冠状动脉搭桥手术。Impella微型轴流心室辅助装置（VAD）（德国亚琛Abiomed公司）是一种带有7毫米导管、流速约为2.5 - 5升/分钟的微型泵。该装置能使心血管手术在不损伤左心室且不导致严重主动脉瓣关闭不全的情况下进行。因此，对于患有严重合并症的患者，由于微型轴流心内泵提供的血流动力学稳定性，可在心脏跳动的非体外循环下进行完全血运重建。如有需要，该泵还可在术后早期支持心脏。我们报道了我国首例使用Impella微型轴流VAD进行的辅助性心脏跳动冠状动脉搭桥手术。该手术针对2例根据欧洲心脏手术风险评估系统（EUROSCORE）测试被认定为高风险的患者实施。
