Nagpal A Dave, Singal Rohit K, Arora Rakesh C, Lamarche Yoan
Divisions of Cardiac Surgery and Critical Care Medicine, Western University / London Health Sciences Centre, London, Ontario, Canada.
Department of Surgery, Sections of Cardiac Surgery and Critical Care, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba / St Boniface General Hospital, Winnipeg, Manitoba, Canada.
Can J Cardiol. 2017 Jan;33(1):110-118. doi: 10.1016/j.cjca.2016.10.023. Epub 2016 Oct 28.
With more than 60 years of continuous development and improvement, a variety of temporary mechanical circulatory support (MCS) devices and implantation strategies exist, each with unique advantages and disadvantages. A thorough understanding of each available device is essential for optimizing patient outcomes in a fiscally responsible manner. In this state of the art review we examine the entire range of commonly available peripheral and centrally cannulated temporary MCS devices, including intra-aortic balloon pumps, the Impella (Abiomed, Danvers, MA) family of microaxial pumps, the TandemHeart (CardiacAssist Inc, Pittsburg, PA) pump and percutaneous cannulas, centrally cannulated centrifugal pumps such as the CentriMag (Thoratec Corp, Pleasanton, CA/St Jude Medical, St Paul, MN/Abbott Laboratories, Abbott Park, IL) and Rotaflow (Maquet Holding BV & Co KG, Rastatt Germany), and extracorporeal membrane oxygenation. Several factors need detailed consideration when contemplating MCS in any given patient, mandating a balanced, algorithmic approach for these sick patients. In this review we describe our approach to MCS, and emphasize the need for multidisciplinary input to consider patient-related, logistical, and institutional factors. Evidence is summarized and referenced where available, but because of the lack of high-quality evidence, current best practice is described. Future directions for investigation are discussed, which will better define patient and device selection, and optimize MCS-specific patient care protocols.
经过60多年的持续发展与改进，现已有多种临时性机械循环支持（MCS）设备及植入策略，每种都有其独特的优缺点。全面了解每种可用设备对于以经济合理的方式优化患者治疗效果至关重要。在本前沿综述中，我们研究了所有常见的外周和中心插管临时性MCS设备，包括主动脉内球囊泵、Impella（阿比奥梅德公司，马萨诸塞州丹弗斯）微轴泵家族、TandemHeart（心脏辅助公司，宾夕法尼亚州匹兹堡）泵及经皮插管、中心插管离心泵，如CentriMag（索拉泰克公司，加利福尼亚州普莱森顿/圣犹达医疗公司，明尼苏达州圣保罗/雅培实验室，伊利诺伊州雅培公园）和Rotaflow（迈柯唯控股有限公司，德国拉施塔特），以及体外膜肺氧合。在考虑为任何特定患者应用MCS时，有几个因素需要详细考量，这就要求针对这些病情严重的患者采取一种平衡的、按算法操作的方法。在本综述中，我们描述了我们应用MCS的方法，并强调需要多学科参与，以考虑与患者相关、后勤及机构方面的因素。如有可用证据，我们会进行总结和引用，但由于缺乏高质量证据，我们描述的是当前的最佳实践。我们还讨论了未来的研究方向，这将更好地确定患者和设备的选择，并优化针对MCS的患者护理方案。
