McGee M G, Parnis S M, Nakatani T, Myers T, Dasse K, Hare W D, Duncan J M, Poirier V L, Frazier O H
Cullen Cardiovascular Surgical Research Laboratories, Texas Heart Institute, Houston 77225.
ASAIO Trans. 1989 Jul-Sep;35(3):614-6. doi: 10.1097/00002480-198907000-00145.
Clinical evaluations are under way of an intracorporeal (abdominally positioned) pulsatile left ventricular assist device (LVAD) that is capable of providing support for extended periods (greater than 30 days) in patients awaiting heart transplantation. The LVAD, developed by Thermo Cardiosystems Inc. (Woburn, MA), has uniquely textured blood contacting surfaces and requires only minimal antithrombotic therapy. It has been used at the Texas Heart Institute as a bridge to transplantation in 11 patients, including 2 who are currently receiving support. Four patients required extended LVAD support (35-132 days); of those, three are doing well at 1.5, 8.5, and 13 months, respectively, after transplantation, and one died of liver failure 49 days after transplantation. The LVAD was operated in a fixed-rate mode to maintain pump flows at 4-8 L/min, resulting in stabilization of hemodynamic and secondary organ function in all patients. Blood chemistry and hematologic values returned to normal during LVAD support in three of four patients. Postoperative anticoagulation was gradually reduced over the course of the trials. The two most recent patients (35 and 132 days) received only oral dipyridamole (75 mg X 3/day) and aspirin (80 mg/day) after the early recovery period (four-six days), resulting in normal prothrombin and partial thromboplastin times. Plasma hemoglobin levels remained within acceptable limits, and there was no evidence of thromboembolism. Blood contacting surfaces were coated with a thin, adherent, biologically derived lining. The initial results indicate that the intracorporeal LVAD, with textured blood contacting surfaces, can effectively support the failing heart for extended periods (greater than 30 days) with minimal antithrombotic therapy.
一种体内（置于腹部）搏动性左心室辅助装置（LVAD）正在进行临床评估，该装置能够为等待心脏移植的患者提供长期（超过30天）支持。由热控心血管系统公司（马萨诸塞州沃本）研发的LVAD具有独特纹理的血液接触表面，仅需极少的抗血栓治疗。它已在德克萨斯心脏研究所用于11例患者作为移植桥梁，其中2例目前仍在接受支持。4例患者需要长期LVAD支持（35 - 132天）；其中3例在移植后分别于1.5个月、8.5个月和13个月情况良好，1例在移植后49天死于肝功能衰竭。LVAD以固定速率模式运行，使泵流量维持在4 - 8升/分钟，所有患者的血流动力学和次要器官功能均得以稳定。4例患者中有3例在LVAD支持期间血液化学和血液学值恢复正常。在试验过程中，术后抗凝逐渐减少。最近的2例患者（35天和132天）在早期恢复期（4 - 6天）后仅接受口服双嘧达莫（75毫克×3次/天）和阿司匹林（80毫克/天），凝血酶原时间和部分凝血活酶时间正常。血浆血红蛋白水平保持在可接受范围内，且无血栓栓塞迹象。血液接触表面涂有一层薄的、附着的、生物衍生衬里。初步结果表明，具有纹理血液接触表面的体内LVAD能够通过极少的抗血栓治疗有效长期（超过30天）支持衰竭心脏。
