Thomas Joseph L, Al-Ameri Hazim, Economides Christina, Shareghi Shahrzad, Abad Damian Grovas, Mayeda Guy, Burstein Steven, Shavelle David M
Division of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
J Invasive Cardiol. 2010 Aug;22(8):360-4.
We sought to describe the use of the TandemHeart percutaneous left ventricular assist device (PVAD) in a group of high-risk patients undergoing complex cardiovascular procedures.
There is a substantial risk of acute decompensation and death in patients with cardiogenic shock or a reduced cardiac reserve undergoing high-risk cardiovascular interventions. The TandemHeart PVAD provides near-total hemodynamic support in this setting.
Thirty-seven high-risk patients underwent placement of the TandemHeart PVAD during 38 separate procedures between April 2007 and April 2009. PVAD insertion was considered emergent if a patient was not expected to survive more than 6 hours without PVAD support. Technical success was defined as successful initiation of the PVAD and completion of the intended interventional procedure.
All 37 patients were in cardiogenic shock or undergoing complex coronary and valvular interventions with a high probability of hemodynamic collapse. The mean (+/- standard deviation) patient age was 73 +/- 14 years; 97% were in either NYHA class III-IV heart failure or cardiogenic shock; and the mean EuroSCORE was 11 +/- 3.4. Indications for ventricular assist device placement included critical aortic stenosis (n = 8), severe left main coronary stenosis (n = 18), severe multivessel coronary stenosis (n = 19) and severe cardiomyopathy (n = 23). Four patients were being managed for fulminant myocarditis, ventricular free-wall rupture, flail mitral valve or severe paravalvular leak. Despite their critical status and frequent (82%) need for post-procedure blood transfusion, this complex and high-risk patient population tolerated PVAD-supported intervention well and technical success was achieved in all patients. Seventy-one percent of patients survived to hospital discharge with improved functional status. Most deaths occurred in patients not expected to survive due to their moribund status and multiorgan failure.
This experience demonstrates the utility and effectiveness of TandemHeart PVAD support in patients with advanced disease, critical clinical status and limited therapeutic options.
我们试图描述串联式人工心脏经皮左心室辅助装置（PVAD）在一组接受复杂心血管手术的高危患者中的应用情况。
心源性休克或心脏储备功能降低的患者在接受高危心血管介入治疗时，存在急性失代偿和死亡的重大风险。在这种情况下，串联式人工心脏PVAD可提供近乎完全的血流动力学支持。
2007年4月至2009年4月期间，37例高危患者在38次单独手术中接受了串联式人工心脏PVAD植入。如果患者在没有PVAD支持的情况下预计存活时间不超过6小时，则PVAD植入被视为紧急情况。技术成功定义为PVAD成功启动并完成预期的介入手术。
所有37例患者均处于心源性休克状态，或正在接受复杂的冠状动脉和瓣膜介入治疗，血流动力学崩溃的可能性很高。患者的平均（±标准差）年龄为73±14岁；97%的患者为纽约心脏协会（NYHA）III-IV级心力衰竭或心源性休克；平均欧洲心脏手术风险评估系统（EuroSCORE）评分为11±3.4。心室辅助装置植入的适应证包括严重主动脉瓣狭窄（n = 8）、严重左主干冠状动脉狭窄（n = 18）、严重多支冠状动脉狭窄（n = 19）和严重心肌病（n = 23）。4例患者因暴发性心肌炎、心室游离壁破裂、连枷样二尖瓣或严重瓣周漏而接受治疗。尽管这些患者病情危急，且术后频繁（82%）需要输血，但这一复杂且高危的患者群体对PVAD支持的介入治疗耐受性良好，所有患者均取得了技术成功。71%的患者存活至出院，功能状态得到改善。大多数死亡发生在因病情垂危和多器官功能衰竭而预计无法存活的患者中。
这一经验证明了串联式人工心脏PVAD支持在患有晚期疾病、临床状况危急且治疗选择有限的患者中的实用性和有效性。
