Chou N-K, Luo J-M, Chi N-H, Wu I-H, Huang S-C, Chen Y-S, Yu H-Y, Tsao C-I, Ko W-J, Chu S-H, Wang S-S
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Transplant Proc. 2012 May;44(4):878-80. doi: 10.1016/j.transproceed.2012.01.084.
Ventricular assist devices have benefited patients with end-stage heart failure as a bridge to heart transplantation (HTx). We present our experiment of HTx using extracorporeal membrane oxygenation (ECMO) with Thoratec pneumatic ventricular assist device (TpVAD).
From May 1996 to June 2011, among 410 patients who underwent HTx 23 required mechanical circulatory support (MCS) with implantation of the TpVAD and 15 (65%) of them received grafts.
The 23 patients included 4 female and 19 male patients of age range 10 to 80 years. Eighteen (78%) of them needed ECMO before TpVAD implantation. Twelve (67%) were implanted with a TpVAD double bridge to HTx. The demand for MCS among patients with acute hemodynamic collapse has led to major improvements in the existing systems such as ECMO with double bridge to TpVAD.
We used ECMO as a rescue procedure for acute hemodynamic deterioration. However, during ECMO support, left ventricular afterload increased. If prolonged support is required, TpVAD might be required: 15 (65%) of patients supported by ECMO with TpVAD needed to a wait a suitable donor. We recommend the application of ECMO for short-term support (within 1 week), and TpVAD as a bridge for medium- or long-term support.
心室辅助装置已使终末期心力衰竭患者受益，作为心脏移植（HTx）的桥梁。我们展示了使用体外膜肺氧合（ECMO）联合Thoratec气动心室辅助装置（TpVAD）进行心脏移植的实验。
1996年5月至2011年6月，在410例行心脏移植的患者中，23例需要机械循环支持（MCS）并植入TpVAD，其中15例（65%）接受了移植。
23例患者包括4名女性和19名男性，年龄范围为10至80岁。其中18例（78%）在植入TpVAD前需要ECMO。12例（67%）植入TpVAD作为心脏移植的双桥。急性血流动力学衰竭患者对MCS的需求促使现有系统如联合TpVAD双桥的ECMO有了重大改进。
我们使用ECMO作为急性血流动力学恶化的抢救措施。然而，在ECMO支持期间，左心室后负荷增加。如果需要长时间支持，可能需要TpVAD：15例（65%）接受ECMO联合TpVAD支持的患者需要等待合适的供体。我们建议将ECMO用于短期支持（1周内），将TpVAD作为中长期支持的桥梁。
