Hatch Jason, Baklanov Dmitri
Department of Internal Medicine, Division of Cardiology, University of Missouri-Kansas City, Kansas City, MO, USA.
Curr Treat Options Cardiovasc Med. 2014 Apr;16(4):293. doi: 10.1007/s11936-014-0293-6.
Percutaneous coronary intervention (PCI) procedures are attempted with increasingly frequency in hemodynamically unstable, high-risk, and complex patients. Hemodynamic support can be advantageous in select patients presenting with acute myocardial infarction and cardiogenic shock. The need for hemodynamic support has recently shifted from patients with hemodynamic collapse to support of patients during high-risk complex PCI procedures during elective cases such as left main disease, multivessel disease, or low-flow heart failure. Currently, the three most common types of percutaneous hemodynamic support devices available in the United States are the intra-aortic balloon pump (IABP) and the left ventricular assist devices TandemHeart and Impella. Each of these devices has its advantages and disadvantages, and an understanding of the role each plays in various pathophysiologic conditions is necessary, as this will assist the practitioner in making the correct decision as to which device will optimize patient outcomes. Recent studies have called into question the need for certain devices in specific situations. However, ongoing clinical trials will provide further insight into the comparative advantages and disadvantages of each and whether one or more is beneficial over another in reducing cardiovascular events and mortality. With continued refinements in device technology, technique, and application, it is anticipated that percutaneous device-based procedures will continue to improve patient outcomes in the most critically ill and highest-risk patients.
经皮冠状动脉介入治疗（PCI）在血流动力学不稳定、高危和复杂患者中的应用频率越来越高。血流动力学支持对某些急性心肌梗死和心源性休克患者可能有益。血流动力学支持的需求最近已从血流动力学崩溃的患者转向在择期病例（如左主干病变、多支血管病变或低流量心力衰竭）的高危复杂PCI手术期间对患者的支持。目前，美国可用的三种最常见的经皮血流动力学支持设备是主动脉内球囊泵（IABP）以及左心室辅助设备TandemHeart和Impella。这些设备各有优缺点，了解每种设备在各种病理生理状况中所起的作用很有必要，因为这将有助于从业者做出正确决策，确定哪种设备能优化患者预后。最近的研究对特定情况下某些设备的必要性提出了质疑。然而，正在进行的临床试验将进一步深入了解每种设备的相对优缺点，以及在降低心血管事件和死亡率方面一种或多种设备是否比另一种更有益。随着设备技术、技术和应用的不断改进，预计基于经皮设备的手术将继续改善最危重和高危患者的预后。
