Division of Cardiothoracic Surgery, University of Rochester Medical Center, Rochester, New York 14642, USA.
ASAIO J. 2013 Sep-Oct;59(5):533-6. doi: 10.1097/MAT.0b013e31829f0e52.
Peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) for acute cardiac failure reestablishes normal oxygen delivery and perfusion. However, VA ECMO can be limited by insufficient ventricular unloading, resulting in thrombus formation and pulmonary edema. Impella 2.5 has been used to unload the left ventricle and provide hemodynamic support during acute heart failure. We present our experience of the Impella 2.5 as an adjunct for left ventricular unloading during peripheral VA ECMO support and as a bridge for the HeartMate II left ventricular assist device (LVAD). An Impella 2.5 was placed in patients who were on peripheral VA ECMO with evidence of left ventricular distension. Patients who were candidates for heart transplant were transitioned to the HeartMate II LVAD. Five patients on VA ECMO with ventricular distension underwent Impella 2.5 implantation, resulting in a decreased left ventricular end-diastolic diameter as measured by echocardiography (7.8 ± 1.4 vs. 6.2 ± 0.8 cm, p = 0.001). Four patients were subsequently transitioned to the HeartMate II LVAD after restoration of end-organ function. Impella 2.5 is a safe means to unload the left ventricle while on peripheral VA ECMO to prevent left ventricle thrombus formation and worsening pulmonary edema in patients transitioning to a HeartMate II LVAD.
体外膜肺氧合（ECMO）可纠正急性心力衰竭患者的低氧血症和组织低灌注。然而，VA-ECMO 可能因心室卸载不足而受到限制，导致血栓形成和肺水肿。Impella 2.5 已被用于在急性心力衰竭期间减轻左心室负担并提供血液动力学支持。我们介绍了在体外膜肺氧合（VA-ECMO）支持期间使用 Impella 2.5 作为左心室卸载辅助装置，并将其作为 HeartMate II 左心室辅助装置（LVAD）桥接的经验。当患者出现左心室扩张并接受 VA-ECMO 治疗时，我们会将 Impella 2.5 放置在患者体内。有心脏移植适应证的患者过渡到 HeartMate II LVAD。5 例因心室扩张而接受 VA-ECMO 治疗的患者接受了 Impella 2.5 植入术，超声心动图测量的左心室舒张末期直径减小（7.8±1.4 vs. 6.2±0.8 cm，p=0.001）。4 例患者在恢复终末器官功能后过渡到 HeartMate II LVAD。在过渡到 HeartMate II LVAD 时，使用 Impella 2.5 是一种安全的方法，可以减轻左心室的负担，防止左心室血栓形成和肺水肿恶化。
