Naqvi Syed Yaseen, Salama Ibrahim G, Yoruk Ayhan, Chen Leway
Department of Cardiology, Advanced Heart Transplant Program, University of Rochester Medical Center Rochester, USA.
Department of Internal Medicine, Unity Hospital Rochester, USA.
Card Fail Rev. 2018 May;4(1):43-45. doi: 10.15420/cfr.2018:22:1.
Cardiac transplantation is the gold standard treatment for patients with advanced congestive heart failure that is refractory to maximal medical therapy. However, donor heart availability remains the major limiting factor, resulting in a large number of patients waiting long periods of time before transplantation. As a result, mechanical circulatory support devices have been increasingly used as a 'bridge' in order to sustain organ function and stabilise haemodynamics while patients remain on the transplant waiting list or undergo left ventricular assist device surgery. Intra aortic balloon pumps (IABP) are commonly used for temporary circulatory support in patients with advanced heart failure. IABP is traditionally placed percutaneously through the transfemoral artery approach. The major limitation with this approach is ambulatory restriction that can promote deconditioning, particularly in situations of prolonged circulatory support. A subclavian/axillary artery approach IABP insertion allows patients to be ambulatory during the pre-transplant period. In this review, we aim to summarise the physiology of IABP, the evidence for its use in advanced CHF and the efficacy and safety of subclavian artery IABP insertion.
心脏移植是对经最大程度药物治疗仍难治的晚期充血性心力衰竭患者的金标准治疗方法。然而，供体心脏的可用性仍然是主要限制因素，导致大量患者在移植前等待很长时间。因此，机械循环支持设备越来越多地被用作“桥梁”，以便在患者仍在移植等待名单上或接受左心室辅助装置手术时维持器官功能并稳定血流动力学。主动脉内球囊泵（IABP）常用于晚期心力衰竭患者的临时循环支持。传统上，IABP通过经股动脉途径经皮放置。这种方法的主要局限性是活动受限，这会导致身体机能下降，尤其是在长期循环支持的情况下。经锁骨下/腋动脉途径插入IABP可使患者在移植前期能够活动。在本综述中，我们旨在总结IABP的生理学、其在晚期CHF中使用的证据以及锁骨下动脉IABP插入的疗效和安全性。
