Department of Cardiology, Heart Center, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
Crit Care. 2011;15(2):R93. doi: 10.1186/cc10098. Epub 2011 Mar 10.
Peripartum cardiomyopathy (PPCM) patients refractory to medical therapy and intra-aortic balloon pump (IABP) counterpulsation or in whom weaning from these therapies is impossible, are candidates for a left ventricular assist device (LVAD) as a bridge to recovery or transplant. Continuous-flow LVADs are smaller, have a better long-term durability and are associated with better outcomes. Extra corporeal membrane oxygenation (ECMO) can be used as a temporary support in patients with refractory cardiogenic shock. The aim of this study was to evaluate the efficacy and safety of mechanical support in acute and critically ill PPCM patients.
This was a retrospective search of the patient database of the Ghent University hospital (2000 to 2010).
Six PPCM-patients were treated with mechanical support. Three patients presented in the postpartum period and three patients at the end of pregnancy. All were treated with IABP, the duration of IABP support ranged from 1 to 13 days. An ECMO was inserted in one patient who presented with cardiogenic shock, multiple organ dysfunction syndrome and a stillborn baby. Two patients showed partial recovery and could be weaned off the IABP. Four patients were implanted with a continuous-flow LVAD (HeartMate II, Thoratec Inc.), including the ECMO-patient. Three LVAD patients were successfully transplanted 78, 126 and 360 days after LVAD implant; one patient is still on the transplant waiting list. We observed one peripheral thrombotic complication due to IABP and five early bleeding complications in three LVAD patients. One patient died suddenly two years after transplantation.
In PPCM with refractory heart failure IABP was safe and efficient as a bridge to recovery or as a bridge to LVAD. ECMO provided temporary support as a bridge to LVAD, while the newer continuous-flow LVADs offered a safe bridge to transplant.
患有围产期心肌病（PPCM）且对药物治疗和主动脉内球囊反搏（IABP）反搏无效或无法从这些治疗中脱机的患者，是左心室辅助装置（LVAD）作为恢复或移植的桥接候选者。连续流 LVAD 体积更小，长期耐用性更好，且结果更好。体外膜肺氧合（ECMO）可在难治性心源性休克患者中用作临时支持。本研究旨在评估机械支持在急性和重症 PPCM 患者中的疗效和安全性。
这是对根特大学医院（2000 年至 2010 年）患者数据库的回顾性搜索。
六例 PPCM 患者接受了机械支持治疗。三名患者在产后期间出现，三名患者在妊娠末期出现。所有患者均接受 IABP 治疗，IABP 支持时间从 1 天到 13 天不等。一名出现心源性休克、多器官功能障碍综合征和死胎的患者插入了 ECMO。两名患者显示部分恢复并能够脱机 IABP。四名患者植入了连续流 LVAD（HeartMate II，Thoratec Inc.），包括 ECMO 患者。三名 LVAD 患者在 LVAD 植入后 78、126 和 360 天成功移植；一名患者仍在移植等待名单上。我们观察到一名患者因 IABP 出现外周血栓并发症，三名 LVAD 患者中有五名出现早期出血并发症。一名患者在移植后两年突然死亡。
在难治性心力衰竭的 PPCM 中，IABP 作为恢复或 LVAD 的桥接是安全有效的。ECMO 提供了作为 LVAD 桥接的临时支持，而较新的连续流 LVAD 则为移植提供了安全的桥接。
