Avgerinos Dimitrios V, DeBois William, Mongero Linda, Krieger Karl, Salemi Arash
Department of Cardiothoracic Surgery, New York Presbyterian-Weill Cornell Medical Center, Weill Cornell Medical College, New York, New York 10065, USA.
J Extra Corpor Technol. 2013 Jun;45(2):136-8.
Right heart failure is a rare but often fatal complication both in the pre- and postoperative setting. Right heart support with a ventricular assist device inserted in the operating room through median sternotomy can be a time-consuming procedure that requires a reoperation for removal. In cases of urgent need of right heart support, a percutaneous technique option may be of benefit. We present our initial experience with a percutaneously inserted right ventricular assist device (RVAD) in an elderly patient with severe right heart failure. An 81-year-old female patient underwent combined aortic and mitral valve replacement at our institution. During the first postoperative evening, the patient sustained sudden cardiovascular collapse and a bedside transesophageal echocardiogram revealed severe right heart failure. A coronary angiogram showed thrombosis of the right coronary artery, which was cleared with a suction device. As a result of the patient's critical condition, it was decided that an RVAD was needed as a bridge to recovery. The patient's condition improved significantly almost immediately. Her right heart function recovered over the next few days and the RVAD was removed at the bedside. She made a complete recovery and was discharged home. This patient is a prime example that a totally RVAD can be inserted in urgent situations easily and safely under fluoroscopic and echocardiographic guidance. More clinical experience with percutaneous RVADs is required to establish this technique as an alternative equivalent to the traditional open method. Right heart failure complicates many heart diseases both in the pre- and the postoperative setting. In cases of urgent need of right heart support, a percutaneous technique of a RVAD is needed for a successful outcome. We present our initial experience with a percutaneously inserted RVAD in an elderly patient with severe postoperative right heart failure.
右心衰竭是一种罕见但在术前和术后均常致命的并发症。通过正中胸骨切开术在手术室插入心室辅助装置进行右心支持是一个耗时的过程，且需要再次手术取出。在急需右心支持的情况下，经皮技术可能有益。我们介绍了在一名患有严重右心衰竭的老年患者中经皮插入右心室辅助装置（RVAD）的初步经验。一名81岁女性患者在我们机构接受了主动脉瓣和二尖瓣联合置换术。术后第一个晚上，患者突然发生心血管崩溃，床边经食管超声心动图显示严重右心衰竭。冠状动脉造影显示右冠状动脉血栓形成，用抽吸装置清除。由于患者病情危急，决定需要RVAD作为恢复的桥梁。患者病情几乎立即明显改善。接下来几天她的右心功能恢复，RVAD在床边取出。她完全康复并出院回家。该患者是一个典型例子，表明在荧光镜和超声心动图引导下，完全可以在紧急情况下轻松、安全地插入RVAD。需要更多经皮RVAD的临床经验，以使该技术成为传统开放方法的等效替代方法。右心衰竭在术前和术后都会使许多心脏病复杂化。在急需右心支持的情况下，成功的结果需要经皮RVAD技术。我们介绍了在一名患有严重术后右心衰竭的老年患者中经皮插入RVAD的初步经验。
