Pennington D G, Kanter K R, McBride L R, Kaiser G C, Barner H B, Miller L W, Naunheim K S, Fiore A C, Willman V
Department of Surgery, St. Louis University Hospital, Mo.
J Thorac Cardiovasc Surg. 1988 Dec;96(6):901-11.
Of currently available methods for mechanical circulatory support, the Pierce-Donachy external pneumatic ventricular assist device has proved to be one of the most versatile and effective. Since 1981, 48 patients, aged 15 to 71 years (mean 43.0), with profound cardiogenic shock refractory to conventional therapy with drugs and intra-aortic balloon support, were supported with the Pierce-Donachy ventricular assist device. There were four patient groups. The largest group consisted of 30 patients with cardiogenic shock after cardiac operations. Nine required left ventricular support, six needed right ventricular support plus an intraaortic balloon pump, and 15 had biventricular support. Duration of support ranged from 3 hours to 22 days (mean 3.6 days). Eight of the first 11 patients died in the operating room of bleeding and/or biventricular failure. However, 16 patients, (53%) had improved cardiac function, 15 (50%) were weaned, and 11 (36%) were discharged. Of the last 19 patients, 47% survived. Frequent factors in nonsurvivors were myocardial infarction (75%) and renal failure (90%). Common complications in all patients were bleeding (52%) and infection (27%). The second group consisted of 11 patients with end-stage cardiomyopathy or acute myocardial infarction in whom the Pierce-Donachy ventricular assist device was used as a bridge to transplantation (left ventricular support, four patients; biventricular support, seven patients). Renal failure, infection, or coagulopathy that precluded transplantation developed in five patients. Five patients were supported for 8 hours to 75 days (mean 20.7 days) before undergoing successful transplantation, with one late death (six months) from rejection owing to noncompliance. One has subsequently undergone successful transplantation after 84 days of support. The third group consisted of four patients, aged 40 to 56 years (means 47.2), who had refractory cardiogenic shock after cardiac transplantation caused by pulmonary hypertension (two patients), hyperacute rejection (one patient), or graft failure (one patient). Despite biventricular support in all four (biventricular assist devices, two patients; right ventricular assist device plus intraaortic balloon pump, two patients), all died of infection and/or renal failure after 12 hours to 6 days (mean 3.4 days) of support. The final group consisted of three patients, aged 36 to 51 years (mean 45), with cardiogenic shock caused by acute myocardial infarction. One patient was supported with biventricular assist devices (3.5 days) and two patients were supported with a left ventricular assist device (8.5 and 15 days).(ABSTRACT TRUNCATED AT 400 WORDS)
在目前可用的机械循环支持方法中，皮尔斯 - 多纳希体外气动心室辅助装置已被证明是用途最广泛、效果最显著的装置之一。自1981年以来，48例年龄在15至71岁（平均43.0岁）、对传统药物治疗和主动脉内球囊支持治疗无效的严重心源性休克患者，接受了皮尔斯 - 多纳希心室辅助装置的支持治疗。患者分为四组。最大的一组由30例心脏手术后发生心源性休克的患者组成。9例需要左心室支持，6例需要右心室支持加主动脉内球囊泵，15例需要双心室支持。支持时间从3小时到22天不等（平均3.6天）。前11例患者中有8例在手术室死于出血和/或双心室衰竭。然而，16例患者（53%）的心功能得到改善，15例（50%）成功撤机，11例（36%）出院。最后19例患者中，47%存活。非存活者的常见因素是心肌梗死（75%）和肾衰竭（90%）。所有患者的常见并发症是出血（52%）和感染（27%）。第二组由11例终末期心肌病或急性心肌梗死患者组成，他们使用皮尔斯 - 多纳希心室辅助装置作为移植桥梁（4例左心室支持；7例双心室支持）。5例患者出现肾衰竭、感染或凝血障碍，无法进行移植。5例患者在成功移植前接受了8小时至75天（平均20.7天）的支持，1例患者因不遵医嘱导致排斥反应，在术后6个月晚期死亡。1例患者在接受84天支持后成功进行了移植。第三组由4例年龄在40至56岁（平均47.2岁）的患者组成，他们在心脏移植后因肺动脉高压（2例）、超急性排斥反应（1例）或移植物功能衰竭（1例）导致难治性心源性休克。尽管4例患者均接受了双心室支持（2例使用双心室辅助装置；2例使用右心室辅助装置加主动脉内球囊泵），但所有患者在接受12小时至6天（平均3.4天）的支持后均死于感染和/或肾衰竭。最后一组由3例年龄在36至51岁（平均45岁）的患者组成，他们因急性心肌梗死导致心源性休克。1例患者接受双心室辅助装置支持（3.5天），2例患者接受左心室辅助装置支持（8.5天和15天）。（摘要截选至400字）
