Bagai Jayant, Webb David, Kasasbeh Ehab, Crenshaw Marshall, Salloum Joseph, Chen Jack, Zhao David
Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, 1215 21st Avenue S., Nashville, TN 37232-8802, USA.
J Invasive Cardiol. 2011 Apr;23(4):141-7.
High-risk percutaneous coronary interventions (PCI), refractory cardiogenic shock and in-lab cardiac arrest are all associated with significant mortality. Percutaneous left ventricular assist devices (pLVAD) and CPS (cardiopulmonary support) have been used to support such patients. However, the extent to which the use of these devices can improve outcomes in this patient subset is not known.
We evaluated clinical features, efficacy and safety outcomes in a retrospective cohort of 39 patients, treated either with pLVAD or CPS for support of high-risk PCI, cardiogenic shock or in-lab cardiac arrest. The Tandem-Heart and a new versatile Multifunctional Percutaneous Heart (MPH) system, with both CPS and LVAD capability, were used and assessed.
19 patients received the TandemHeart and 20 received the MPH system. The MPH system was used as a pLVAD in 12 and to provide CPS in 8 patients. Procedural efficacy was 100%. Emergent institution of CPS, in the setting of cardiac arrest, was able to support 7 out of 8 patients and resulted in a 50% survival to hospital discharge rate. Overall, in-hospital death and 30-day major adverse cardiac event rates were 28.2% and 35.9%, respectively. The risk of vascular complications and bleeding was relatively small.
pLVADs are effective in supporting patients during high-risk cardiac (coronary and structural heart) interventions, with a low risk of device-related complications. Further, the expeditious use of CPS in the catheterization laboratory can improve survival in a selected subset of patients with refractory cardiogenic shock and cardiac arrest.
高风险经皮冠状动脉介入治疗（PCI）、难治性心源性休克和实验室内心脏骤停均与显著的死亡率相关。经皮左心室辅助装置（pLVAD）和心肺支持（CPS）已被用于支持此类患者。然而，这些装置的使用能在多大程度上改善该患者亚组的预后尚不清楚。
我们评估了39例接受pLVAD或CPS治疗以支持高风险PCI、心源性休克或实验室内心脏骤停的患者的回顾性队列中的临床特征、疗效和安全性结果。使用并评估了Tandem-Heart和一种新型多功能经皮心脏（MPH）系统，该系统兼具CPS和LVAD功能。
19例患者接受了TandemHeart，20例接受了MPH系统。MPH系统在12例患者中用作pLVAD，在8例患者中用于提供CPS。手术成功率为100%。在心脏骤停情况下紧急启用CPS能够支持8例患者中的7例，并使出院生存率达到50%。总体而言，住院死亡率和30天主要不良心脏事件发生率分别为28.2%和35.9%。血管并发症和出血风险相对较小。
pLVAD在高风险心脏（冠状动脉和结构性心脏病）介入治疗期间有效支持患者，与装置相关的并发症风险较低。此外，在导管室中迅速使用CPS可提高难治性心源性休克和心脏骤停患者特定亚组的生存率。
