Nersesian Gaik, Hennig Felix, Müller Marcus, Mulzer Johanna, Tsyganenko Dmytro, Starck Christoph, Gromann Tom, Falk Volkmar, Potapov Evgenij, Schoenrath Felix
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Ann Cardiothorac Surg. 2019 Jan;8(1):76-83. doi: 10.21037/acs.2018.12.01.
Temporary mechanical circulatory support (MCS) offers a valuable option for treatment of refractory heart failure. We present our experience with selected MCS devices in cardiogenic shock of different etiologies.
We retrospectively studied patients who were treated in our institution between 01/2016 and 07/2018. Patients receiving only veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support were excluded. Left ventricular support patients received Impella; right ventricular support was conducted using Levitronix CentriMag.
Thirty-seven patients received an Impella left ventricular assist device (LVAD). Etiology was: acute on chronic ischemic cardiomyopathy (ICMP; n=12), acute myocardial infarction (AMI; n=11), dilated cardiomyopathy (DCMP; n=7) and toxic cardiomyopathy (TCMP; n=2). Two patients presented with postcardiotomy shock and acute myocarditis, respectively. In one case, Takotsubo cardiomyopathy was diagnosed. Impella was used solely in 28 patients (Impella group) with an in-hospital survival of 37%. In nine patients, Impella was used in combination with extracorporeal life support (ECLS) implantation (ECMELLA group)-in-hospital survival was 33%. In the Impella group six patients recovered, six received a long-term VAD and 16 died on device. In the ECMELLA group one patient recovered, three received a long-term VAD and five died. The majority of CentriMag implantations as a right ventricular assist device (RVAD) were necessary after LVAD implantation (n=52); of these patients, 14 recovered, eight received long-term VAD and 30 died. The remaining 17 patients were supported by RVAD due to AMI (n=7); postcardiotomy (n=7); right heart failure after heart transplantation (n=2) and ICMP (n=1). Six of these patients recovered, two required long-term VAD and nine died.
Survival after MCS implantation for left as well as right heart failure in cardiogenic shock remains low, but is superior to that of patients without mechanical support. Short-term MCS remains an option of choice if right, left or biventricular support is needed.
临时机械循环支持（MCS）为治疗难治性心力衰竭提供了一种有价值的选择。我们介绍了我们在不同病因的心源性休克中使用特定MCS设备的经验。
我们回顾性研究了2016年1月至2018年7月在我们机构接受治疗的患者。仅接受静脉-动脉体外膜肺氧合（VA-ECMO）支持的患者被排除。左心室支持患者接受Impella；右心室支持使用Levitronix CentriMag进行。
37例患者接受了Impella左心室辅助装置（LVAD）。病因包括：慢性缺血性心肌病急性发作（ICMP；n = 12）、急性心肌梗死（AMI；n = 11）、扩张型心肌病（DCMP；n = 7）和中毒性心肌病（TCMP；n = 2）。2例患者分别出现心脏术后休克和急性心肌炎。1例患者被诊断为应激性心肌病。Impella仅用于28例患者（Impella组），院内生存率为37%。9例患者中，Impella与体外生命支持（ECLS）植入联合使用（ECMELLA组），院内生存率为33%。在Impella组中，6例患者康复，6例接受了长期VAD，16例在使用设备期间死亡。在ECMELLA组中，1例患者康复，3例接受了长期VAD，5例死亡。作为右心室辅助装置（RVAD）的CentriMag植入大多数是在LVAD植入后进行的（n = 52）；这些患者中，14例康复，8例接受了长期VAD，30例死亡。其余17例患者因AMI（n = 7）；心脏术后（n = 7）；心脏移植后右心衰竭（n = 2）和ICMP（n = 1）接受RVAD支持。这些患者中，6例康复，2例需要长期VAD，9例死亡。
心源性休克中左、右心力衰竭植入MCS后的生存率仍然较低，但优于没有机械支持的患者。如果需要右心、左心或双心室支持，短期MCS仍然是一种选择。
