Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Division of Cardiology, Winthrop University Hospital, Mineola, New York.
J Am Coll Cardiol. 2015 May 19;65(19):e7-e26. doi: 10.1016/j.jacc.2015.03.036. Epub 2015 Apr 7.
Although historically the intra-aortic balloon pump has been the only mechanical circulatory support device available to clinicians, a number of new devices have become commercially available and have entered clinical practice. These include axial flow pumps, such as Impella(®); left atrial to femoral artery bypass pumps, specifically the TandemHeart; and new devices for institution of extracorporeal membrane oxygenation. These devices differ significantly in their hemodynamic effects, insertion, monitoring, and clinical applicability. This document reviews the physiologic impact on the circulation of these devices and their use in specific clinical situations. These situations include patients undergoing high-risk percutaneous coronary intervention, those presenting with cardiogenic shock, and acute decompensated heart failure. Specialized uses for right-sided support and in pediatric populations are discussed and the clinical utility of mechanical circulatory support devices is reviewed, as are the American College of Cardiology/American Heart Association clinical practice guidelines.
虽然主动脉内球囊反搏泵在历史上一直是临床医生唯一可用的机械循环支持装置,但许多新型装置已经商业化并进入临床实践。这些装置包括轴流泵,如 Impella(®);左心房至股动脉旁路泵,特别是 TandemHeart;以及用于建立体外膜氧合的新装置。这些装置在血流动力学效应、插入、监测和临床适用性方面有显著差异。本文回顾了这些装置对循环的生理影响及其在特定临床情况下的应用。这些情况包括接受高风险经皮冠状动脉介入治疗的患者、出现心源性休克的患者和急性失代偿性心力衰竭的患者。讨论了右侧支持的特殊用途和儿科人群中的应用,并回顾了机械循环支持装置的临床实用性,以及美国心脏病学会/美国心脏协会的临床实践指南。