Zhigalov Konstantin, Mashhour Ahmed, Szczechowicz Marcin, Mkalaluh Sabreen, Baranov Aleksey, Easo Jerry, Altmann Steffen, Eichstaedt Harald C, Weymann Alexander
Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
Department of Cardiac Surgery, E.A. Vagner Perm State Medical University, S.G. Sukhanov Federal Center of Cardiovascular Surgery, Perm, Russian Federation.
Am J Case Rep. 2019 Jul 17;20:1035-1038. doi: 10.12659/AJCR.916404.
BACKGROUND We report a 66-year-old patient who received implantation of HeartMate II LVAD (St. Jude Medical, Minneapolis, MN, USA) as destination therapy 10 years ago. CASE REPORT Preoperatively, the patient developed acute heart failure due to transmural myocardial infarction requiring catecholamine therapy and intra-aortic balloon pump. Echocardiography revealed a left ventricular ejection fraction of 15%. We saw an indication for left ventricular assist device (LVAD) implantation. The intraoperative course was uncomplicated. The operation time was 153 minutes and the cardiopulmonary bypass time was 69 minutes. The procedure was performed in normothermia, and no further combined procedures were necessary. Only one re-hospitalization, due to driveline infection, was required. Once a month, the patient visited our heart failure outpatient clinic for laboratory control, echocardiographic examination, and device measurement. There was always a normal LVAD function. During the 10 years of follow-up, the patient did not have any other complications. CONCLUSIONS Patients with a strict indication for LVAD and fewer risk factors can show a relatively uncomplicated postoperative course. Our case report demonstrates the opportunity to care for a patient for years using LVAD. Modern LVADs are reliable cardiac support systems as destination therapy from the long-term perspective. Careful patient selection, timely decision on LVAD implantation, and structured patient care are critical.
背景 我们报告一名66岁患者，其于10年前接受了HeartMate II左心室辅助装置（LVAD，美国明尼阿波利斯市圣犹达医疗公司）植入作为终末期治疗。病例报告 术前，该患者因透壁性心肌梗死发生急性心力衰竭，需要使用儿茶酚胺治疗和主动脉内球囊反搏。超声心动图显示左心室射血分数为15%。我们认为有植入左心室辅助装置（LVAD）的指征。术中过程顺利。手术时间为153分钟，体外循环时间为69分钟。手术在常温下进行，无需进一步的联合手术。仅因导线感染再次住院一次。患者每月到我们的心衰门诊进行实验室检查、超声心动图检查和装置测量。LVAD功能一直正常。在10年的随访期间，患者未出现任何其他并发症。结论 有严格LVAD植入指征且危险因素较少的患者术后病程可能相对简单。我们的病例报告显示了使用LVAD对患者进行多年护理的可能性。从长期来看，现代LVAD作为终末期治疗是可靠的心脏支持系统。仔细的患者选择、及时决定植入LVAD以及系统的患者护理至关重要。
