Saeed Diyar, Maxhera Bujar, Kamiya Hiroyuki, Lichtenberg Artur, Albert Alexander
Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
Clinic for Cardiovascular Surgery, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany.
J Thorac Cardiovasc Surg. 2015 Mar;149(3):927-32. doi: 10.1016/j.jtcvs.2014.10.104. Epub 2014 Nov 1.
Temporary right ventricular assist devices (RVADs) may be required to support patients with perioperative refractory right ventricular failure (RVF). We report on our experience using a different technique of RVAD implantation that does not necessitate resternotomy at the time of RVAD removal.
Patients with perioperative RVF who underwent temporary RVAD implantation between January 2010 and February 2014 were reviewed. A dacron graft was attached to the pulmonary artery and passed through a subxiphoid exit, where the RVAD outflow cannula was inserted. The inflow cannula was percutaneously cannulated in the femoral vein, and the sternum was primarily closed. On the day of RVAD explantation, the outflow graft of the RVAD was pulled and ligated, and the insertion site was secondarily closed. The RVAD inflow cannula was removed, and direct pressure was applied.
Twenty-one patients (age 58 ± 14 years) were supported. Seventeen patients (81%) had RVF after left ventricular assist device implantation, and 4 patients developed postcardiotomy RVF. The median duration of RVAD support was 9 days (range: 2-88 days). Eleven patients (52%) were successfully weaned from the RVAD. Two patients were bridged to transplantation. Eight patients died on left ventricular assist device and/or RVAD support. The survival rates to discharge or heart transplantation, and to 1-year, were 62% and 52%, respectively.
No technical issues were encountered in this large series of RVAD implantations using the described technique for various forms of postoperative RVF. Extended support duration and reduction of resternotomy risks may be the main advantages of this technique compared with conventional RVAD implantation methods.
对于围手术期难治性右心室衰竭（RVF）患者，可能需要临时右心室辅助装置（RVAD）来提供支持。我们报告了一种不同的RVAD植入技术的应用经验，该技术在移除RVAD时无需再次开胸。
回顾了2010年1月至2014年2月期间接受临时RVAD植入的围手术期RVF患者。将涤纶补片连接到肺动脉并通过剑突下切口引出，在此处插入RVAD流出插管。流入插管经皮插入股静脉，胸骨一期关闭。在RVAD取出当天，将RVAD的流出补片牵拉并结扎，插入部位二期关闭。移除RVAD流入插管并直接压迫止血。
共支持了21例患者（年龄58±14岁）。17例患者（81%）在植入左心室辅助装置后出现RVF，4例患者发生心脏切开术后RVF。RVAD支持的中位持续时间为9天（范围：2 - 88天）。11例患者（52%）成功脱离RVAD。2例患者过渡到移植。8例患者在左心室辅助装置和/或RVAD支持下死亡。出院或心脏移植的生存率以及1年生存率分别为62%和52%。
在这一系列使用所述技术进行的各种形式术后RVF的RVAD植入中，未遇到技术问题。与传统RVAD植入方法相比，延长支持时间和降低再次开胸风险可能是该技术的主要优势。
