Tanaka Akiko, Tuladhar Sampura M, Onsager David, Asfaw Zewditu, Ota Takeyoshi, Juricek Colleen, Lahart Meghan, Lonchyna Vassyl A, Kim Gene, Fedson Savitri, Sayer Gabriel, Uriel Nir, Jeevanandam Valluvan
Department of Surgery, University of Chicago Medicine, Chicago, Illinois.
Department of Therapy Services, University of Chicago Medicine, Chicago, Illinois.
Ann Thorac Surg. 2015 Dec;100(6):2151-7; discussion 2157-8. doi: 10.1016/j.athoracsur.2015.05.087. Epub 2015 Jul 28.
A subclavian intraaortic balloon pump (SC-IABP) can help to optimize patients with advanced congestive heart failure as a bridge to definitive therapy. We retrospectively reviewed our experience to assess the application and safety of this technique.
We studied 88 patients with decompensated advanced congestive heart failure who received SC-IABP placement between January 2011 and December 2014. The SC-IABP was placed through a graft in the subclavian artery. The intended therapeutic goals for SC-IABP were bridge to transplant (n = 61), mechanical circulatory support (n = 21), or recovery (n = 6). Success was defined as stroke-free survival, achievement of therapeutic goal, and maintenance or improvement in renal function, hemodynamics, and physical conditioning through ambulation and rehabilitation.
Eighty patients were successfully bridged to the next therapy (transplant 93.4%, mechanical circulatory support 95.3%, recovery 50%). There was no mortality related to SC-IABP placement. Duration of SC-IABP support was 4 to 135 days (median 21). Failure was attributed to escalation of support (n = 5), stroke (n = 2), and sepsis (n = 1). Mean pulmonary artery pressure significantly improved from 33 ± 11 mm Hg to 28 ± 8 mm Hg (p < 0.05). Eighty-four patients (95.5%) ambulated more than 3 times a day. Two-minute step test demonstrated significant improvement, from 50 ± 9 steps to 90 ± 23 steps (n = 16, p < 0.001). Specific complications of SC-IABP included exchange/repositioning (n = 26, 29.5%), subclavian artery thrombosis (n = 1, 1.1%), and reexploration for hematoma (n = 4, 4.5%) and infection (n = 2, 2.3%). No distal thromboembolic events were observed.
The SC-IABP provided excellent hemodynamic support with minimal morbidity and mortality, allowed for extensive rehabilitation, and permitted more than 90% of patients to receive their intended therapy. Therefore, SC-IABP is a compelling bridge device for patients with advanced congestive heart failure.
锁骨下动脉主动脉内球囊反搏（SC-IABP）可作为一种桥梁手段，帮助优化晚期充血性心力衰竭患者的病情，以便进行确定性治疗。我们回顾性分析了我们的经验，以评估该技术的应用及安全性。
我们研究了88例在2011年1月至2014年12月期间接受SC-IABP植入的失代偿性晚期充血性心力衰竭患者。SC-IABP通过锁骨下动脉的移植物植入。SC-IABP的预期治疗目标为过渡到移植（n = 61）、机械循环支持（n = 21）或恢复（n = 6）。成功定义为无卒中生存、实现治疗目标，以及通过活动和康复使肾功能、血流动力学和身体状况维持或改善。
80例患者成功过渡到下一步治疗（移植93.4%，机械循环支持95.3%，恢复50%）。未发生与SC-IABP植入相关的死亡。SC-IABP支持时间为4至135天（中位数21天）。失败原因包括支持力度升级（n = 5）、卒中（n = 2）和脓毒症（n = 1）。平均肺动脉压从33±11mmHg显著改善至28±8mmHg（p < 0.05）。84例患者（95.5%）每天活动超过3次。两分钟阶梯试验显示有显著改善，从50±9步增至90±23步（n = 16，p < 0.001）。SC-IABP的特定并发症包括交换/重新定位（n = 26，29.5%）、锁骨下动脉血栓形成（n = 1，1.1%）、因血肿再次手术探查（n = 4，4.5%）和感染（n = 2，2.3%）。未观察到远端血栓栓塞事件。
SC-IABP提供了出色的血流动力学支持，并发症和死亡率极低，允许进行广泛的康复治疗，并使超过90%的患者能够接受预期治疗。因此，SC-IABP是晚期充血性心力衰竭患者的一种极具吸引力的桥梁装置。
