Deutsches Herzzentrum Berlin, Berlin, Germany.
ASAIO J. 2011 Jul-Aug;57(4):333-5. doi: 10.1097/MAT.0b013e31821798c4.
In this case report, we describe a modification of the biventricular implantation of the HeartWare HVAD. A 28-year-old man with dilative cardiomyopathy presented with biventricular decompensation. The patient underwent implantation of two HeartWare HVADs for biventricular support. Because of low flow of the right pump (2 L/min), a right ventricular angiogram and repeated transesophageal echocardiography (TEE) were done and showed that the pump was compressing the right ventricle. Operative revision was performed, resulting in removal of the right pump and placement into the right atrium, so that it was located in the right pleural cavity. The HVAD fixation ring on the free wall of the right ventricle was left in place, and the opening was closed with an individually designed titanium plug. The findings of this case are that implantation of the HeartWare HVAD for right ventricular (RV) support may be safely performed in atrial position, with individually designed plugs allowing safe and quick removal of the HeartWare pump. This might be used as a "bail-out" strategy when necessary.
在本病例报告中，我们描述了一种 HeartWare HVAD 的双心室植入方式的改良。一位 28 岁的扩张型心肌病男性患者出现双心室失代偿。该患者接受了两个 HeartWare HVAD 的植入以进行双心室支持。由于右泵的流量低（2 L/min），进行了右心室血管造影和重复经食管超声心动图（TEE）检查，结果显示泵正在压迫右心室。进行了手术修正，导致移除了右泵并将其放置在右心房中，使其位于右胸腔内。右心室游离壁上的 HVAD 固定环保留在原处，并用单独设计的钛插件封闭开口。本病例的发现是，将 HeartWare HVAD 植入右心室（RV）以提供支持，可以安全地在心房位置进行，使用单独设计的插件可以安全、快速地移除 HeartWare 泵。当需要时，这可能被用作“救援”策略。
