Schibilsky David, Lausberg Henning, Haller Christoph, Lenglinger Matthias, Woernle Barbara, Haeberle Helene, Rosenberger Peter, Walker Tobias, Schlensak Christian
Department of Thoracic and Cardiovascular Surgery, University Medical Center Tuebingen, Tuebingen, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Tuebingen, Tuebingen, Germany.
Artif Organs. 2015 Aug;39(8):660-3. doi: 10.1111/aor.12529. Epub 2015 Jul 6.
The catheter-based Impella 5.0 left ventricular assist device (LVAD) is a powerful and less invasive alternative for patients in cardiogenic shock. The use of this device as a primary mechanical circulatory support strategy in INTERMACS II patients should be evaluated. From April 2014 to August 2014, eight Impella 5.0 devices were implanted in seven patients via the axillary artery access (six right and two left). We analyzed the outcome of the four patients in whom the Impella 5.0 device was implanted for the purpose of primary stabilization of cardiogenic shock (INTERMACS II). The remaining three patients had a contraindication for a permanent LVAD and received the device for prolonged weaning from extracorporeal life support (ECLS) system. The implantation of the Impella 5.0 was technically successful in all patients and resulted in the stabilization of the clinical situation. All four patients could be bridged to a long-term device (n = 3) or to cardiac recovery (n = 1). In one patient, 2 days of ECLS support was necessary because of pump thrombosis after 31 days of Impella 5.0 support. One patient with bronchopneumonia had the Impella 5.0 exchanged from the right to the left axillary artery after 22 days of support because of the progressive loss of purge flow and the need for longer bridging to a permanent LVAD. The last patient was supported for giant-cell myocarditis for 22 days and bridged to cardiac recovery. All patients were transferred to the intensive care unit with the Impella device in place. In INTERMACS II situations, the implantation of the Impella 5.0 via the right or left axillary access allowed additional time for decision making. Early patient mobilization, including walking with the Impella device in place, optimized the conditions for either weaning or the implantation of a permanent LVAD. This novel technique of left axillary approach leads to more flexibility in the case of anatomical- or device-related contraindications to right-side access, or when the device needs to be exchanged while continuous support is necessary.
基于导管的Impella 5.0左心室辅助装置（LVAD）对于心源性休克患者而言是一种功能强大且侵入性较小的替代方案。应评估将该装置用作INTERMACS II级患者的主要机械循环支持策略的情况。2014年4月至2014年8月，通过腋动脉入路在7例患者中植入了8台Impella 5.0装置（6例右侧，2例左侧）。我们分析了4例为实现心源性休克（INTERMACS II级）初步稳定而植入Impella 5.0装置的患者的结局。其余3例患者存在永久性LVAD的禁忌证，接受该装置以从体外生命支持（ECLS）系统长期撤机。Impella 5.0的植入在所有患者中技术上均获成功，并使临床情况得以稳定。所有4例患者均成功过渡到长期装置（n = 3）或实现心脏恢复（n = 1）。1例患者在Impella 5.0支持31天后因泵血栓形成而需要2天的ECLS支持。1例支气管肺炎患者在支持22天后因冲洗血流逐渐减少且需要更长时间过渡到永久性LVAD而将Impella 5.0从右侧腋动脉更换至左侧腋动脉。最后1例患者因巨细胞性心肌炎接受支持22天并实现心脏恢复。所有患者均在植入Impella装置的情况下转入重症监护病房。在INTERMACS II级情况下，通过右侧或左侧腋动脉入路植入Impella 5.0可提供更多决策时间。早期患者活动，包括带着Impella装置行走，优化了撤机或植入永久性LVAD的条件。这种新颖的左腋动脉入路技术在存在右侧入路的解剖学或装置相关禁忌证时，或在需要在持续支持的同时更换装置的情况下，可带来更大的灵活性。
