Torregrossa Gianluca, Anyanwu Anelechi, Zucchetta Fabio, Gerosa Gino
1 Department of Cardiothoracic Surgery, Mount Sinai Health System, New York, USA ; 2 Department of Cardiac Surgery, University of Padua, Padova, Italy.
Ann Cardiothorac Surg. 2014 Nov;3(6):612-20. doi: 10.3978/j.issn.2225-319X.2014.11.07.
The SynCardia total artificial heart (TAH) currently provides the most definitive option for patients with biventricular failure who are not candidates for isolated left ventricular (LV) assist device placement. The techniques for implantation are adaptable to almost all patients with advanced heart failure, including those with severe biventricular cardiomyopathy, complex congenital heart disease, failed LV assist devices, failed transplantations, and acquired structural heart defects that have failed or are not amenable to conventional surgical treatment. Over the years, the implantation technique has evolved in order to minimize the surgical invasiveness of the procedure, in anticipation of additional future surgery. Meticulous hemostasis with double layer sutures, use of Gore-Tex sheets around the TAH and the pericardial cavity, and use of tissue expanders to avoid contraction of pericardial cavity around the device are discussed in detail in the following report. Additionally, we will provide our experience with implantation of TAH in various challenging scenarios, such as patients with a small chest cavity, congenital heart defects, and simultaneous use of extracorporeal membrane oxygenation (ECMO).
目前，SynCardia全人工心脏（TAH）为双心室衰竭患者提供了最明确的治疗选择，这些患者不适合植入单独的左心室（LV）辅助装置。植入技术适用于几乎所有晚期心力衰竭患者，包括那些患有严重双心室心肌病、复杂先天性心脏病、LV辅助装置功能衰竭、移植失败以及获得性结构性心脏缺陷且传统手术治疗失败或不适用的患者。多年来，为了在预期未来进行额外手术时尽量减少手术的侵袭性，植入技术不断发展。以下报告将详细讨论使用双层缝线进行细致止血、在TAH和心包腔周围使用戈尔特斯片材以及使用组织扩张器以避免装置周围心包腔收缩的方法。此外，我们还将分享在各种具有挑战性的情况下植入TAH的经验，例如胸腔较小的患者、先天性心脏缺陷患者以及同时使用体外膜肺氧合（ECMO）的患者。
