Sayed Sameh, Schimmer Christoph, Shade Ina, Leyh Rainer, Aleksic Ivan
Department of Cardiothoracic Surgery, Zentrum Operative Medizine, University of Würzburg, Oberdürrbacher Str.6, 97080, Würzburg, Germany.
Department of Cardiothoracic Surgery, Assiut University, Assiut, Egypt.
J Cardiothorac Surg. 2017 May 22;12(1):38. doi: 10.1186/s13019-017-0594-4.
Mechanical circulatory support is a common practice nowadays in the management of patients after cardiogenic shock due to myocardial infarction. The single or combined use of one or more devices for mechanical support depends not only on the advantage or disadvantage of these devices but also on the timing of use of these devices before the development of multi organ failure. In our case we used more than one tool for mechanical circulatory support during the prolonged and complicated course of our patient with postcardiotomy cardiogenic shock after coronary artery bypass surgery.
We describe the combined use of Impella 5.0 and veno- pulmonary extra corporeal membrane oxygenation (VP-ECMO) for biventricular failure in a 52 years-old man. He presented with cardiogenic shock after inferior wall ST-elevation myocardial infarction. After emergency coronary artery bypass surgery and failure to wean from extracorporeal circulation we employed V-P ECMO and consecutively Impella 5.0 to manage the primarily failing right and secondarily failing left ventricles. He remained hemodynamically stable on both Impella 5.0 and VP-ECMO until Heart Mate II left ventricular assist device implantation on the 14 postoperative day. Right sided support was weaned on 66 postoperative day. The patient remained in the intensive care unit for 77 days. During his prolonged stay, he underwent renal replacement therapy and tracheostomy with complete recovery. Six months later, he was successfully heart transplanted and has completed three and half years of unremarkable follow up.
The combined use of VP ECMO and Impella 5.0 is effective in the management of postcardiotomy biventricular failure as a bridge for further mechanical support or heart transplantation.
在因心肌梗死导致的心源性休克患者的管理中，机械循环支持如今是一种常见的做法。使用一种或多种设备进行机械支持的单一或联合使用不仅取决于这些设备的优缺点，还取决于在多器官功能衰竭发生之前使用这些设备的时机。在我们的病例中，在一名冠状动脉搭桥手术后发生心脏切开术后心源性休克的患者漫长而复杂的病程中，我们使用了不止一种机械循环支持工具。
我们描述了一名52岁男性因双心室衰竭联合使用Impella 5.0和静脉 - 肺体外膜肺氧合（VP - ECMO）的情况。他在下壁ST段抬高型心肌梗死后出现心源性休克。在紧急冠状动脉搭桥手术且无法脱离体外循环后，我们采用了V - P ECMO，随后使用Impella 5.0来管理最初衰竭的右心室和继发衰竭的左心室。在术后第14天植入HeartMate II左心室辅助装置之前，他在Impella 5.0和VP - ECMO上均保持血流动力学稳定。术后第66天停用右侧支持。患者在重症监护病房住院77天。在他的长期住院期间，他接受了肾脏替代治疗和气管切开术，并完全康复。六个月后，他成功接受了心脏移植，并已完成三年半的随访，情况良好。
VP ECMO和Impella 5.0联合使用在管理心脏切开术后双心室衰竭方面是有效的，可作为进一步机械支持或心脏移植的桥梁。
