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DuraHeart™ 磁悬浮左心室辅助装置:大阪大学的经验。

DuraHeart™ magnetically levitated left ventricular assist device: Osaka University experience.

机构信息

Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

出版信息

Circ J. 2013;77(7):1736-41. doi: 10.1253/circj.cj-12-1410. Epub 2013 Apr 18.

Abstract

BACKGROUND

The DuraHeart left ventricular assist device (LVAD) is the world's first approved magnetically levitated implantable centrifugal pump. We report our initial experience with the DuraHeart as a bridge to heart transplantation.

METHODS AND RESULTS

Between 2008 and 2011, 23 patients (17 males; mean age 35 years, range 16-53 years) with endstage heart failure underwent implantation with the DuraHeart LVAD at Osaka University Hospital. Of those, 7 underwent conversion surgery from a Nipro paracorporeal LVAD to the DuraHeart. There were no deaths during the mean support period of 559±241 days (176-999 days). In total, 17 patients (74%) remain with the LVAD and 5 (22%) underwent heart transplantation after 580±302 days (176-982 days) of support. Major adverse events included 8 (34%) driveline/pocket infections, 4 (17%) cerebrovascular accidents, 4 (17%) right heart failures requiring mechanical support, and 3 (13%) mechanical device failures (magnetic levitation failure caused by driveline fracture). Of the 5 patients who developed pump pocket infection, 3 underwent previous conversion surgery from the Nipro LVAD.

CONCLUSIONS

Our initial experience with the DuraHeart LVAD in Japan demonstrated excellent long-term survival with acceptable rates of adverse events. With refinement of the system, including mechanical durability, this pump will further enhance the quality of life for patients who require long-term mechanical circulatory support.

摘要

背景

DuraHeart 左心室辅助装置(LVAD)是世界上首个获准的磁悬浮植入式离心泵。我们报告了使用 DuraHeart 作为心脏移植桥接的初步经验。

方法和结果

2008 年至 2011 年期间,23 名终末期心力衰竭患者在大阪大学医院植入 DuraHeart LVAD。其中 7 名患者从尼普洛体外 LVAD 转换为 DuraHeart。在平均 559±241 天(176-999 天)的支持期间,无死亡。总共有 17 名患者(74%)仍在使用 LVAD,5 名患者(22%)在 580±302 天(176-982 天)的支持后接受了心脏移植。主要不良事件包括 8 例(34%)的导线/囊袋感染、4 例(17%)的脑血管意外、4 例(17%)需要机械支持的右心衰竭和 3 例(13%)的机械装置故障(由导线断裂引起的磁悬浮故障)。在 5 名发生泵囊袋感染的患者中,有 3 名患者曾接受过尼普洛 LVAD 的先前转换手术。

结论

我们在日本使用 DuraHeart LVAD 的初步经验表明,长期生存效果极好,不良事件发生率可接受。随着系统的改进,包括机械耐久性的提高,这种泵将进一步提高需要长期机械循环支持的患者的生活质量。

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