Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska.
Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska; Division of Cardiology, Omaha Children's Hospital and Medical Center, Omaha, Nebraska.
Semin Thorac Cardiovasc Surg. 2020;32(3):467-472. doi: 10.1053/j.semtcvs.2020.01.012. Epub 2020 Feb 10.
Left ventricular assist device (LVAD) deactivation may be considered in cases of left ventricular recovery, pump thrombosis, infection, and end-of-life palliation. Surgical pump explantation remains the principal method, but percutaneous deactivation presents a safe and effective alternative. We have developed a formal program for percutaneous LVAD deactivation within our advanced heart failure program including patient selection criteria, preprocedure testing, a procedural algorithm, and a postprocedure care plan. Patient selection for percutaneous LVAD deactivation required review by an interdisciplinary heart transplant team including reason for deactivation, cardiac function, surgical risk, and patient preference. All candidates underwent LVAD ramp studies with both transthoracic echocardiography and right heart catheterization assessment. Deactivation was performed under general anesthesia with transesophageal echocardiography guidance. Three Amplatzer Vascular Plug IIs (Abbott, St. Paul, MN) were deployed in the LVAD outflow cannula with the proximal edge of the third plug aligned with the aortic anastomosis of the graft as guided by angiography and 3-dimensional transesophageal echocardiography. In a separate procedure, the LVAD drive line was transected below the skin, which was closed surgically over the driveline stump. Anticoagulation was continued for at least 3 months. Since initiation in January 2017, our program has performed 7 percutaneous LVAD deactivation procedures. All procedures have been successful, 5 of the patients remain medically managed, and 2 have proceeded to heart transplant. Percutaneous LVAD deactivation provides an alternative to surgical explantation. A percutaneous LVAD deactivation program is an important component of an advanced heart failure program.
左心室辅助装置（LVAD）的停用可考虑在左心室恢复、泵血栓形成、感染和生命末期姑息治疗的情况下。外科泵取出仍然是主要方法，但经皮停用是一种安全有效的替代方法。我们在我们的先进心力衰竭计划中制定了一个正式的经皮 LVAD 停用计划，包括患者选择标准、术前测试、程序算法和术后护理计划。经皮 LVAD 停用的患者选择需要由包括停用原因、心脏功能、手术风险和患者偏好在内的多学科心脏移植团队进行审查。所有候选者均进行了 LVAD 斜坡研究，包括经胸超声心动图和右心导管评估。停用在全身麻醉下进行，使用经食管超声心动图引导。在 LVAD 流出套管中部署了三个 Amplatzer Vascular Plug IIs（雅培，明尼苏达州圣保罗），第三个塞子的近端边缘与移植物的主动脉吻合口对齐，由血管造影和 3 维经食管超声心动图引导。在单独的程序中，LVAD 驱动线在皮肤下方被切断，然后通过手术将皮肤闭合在驱动线残端上。抗凝治疗至少持续 3 个月。自 2017 年 1 月开始，我们的计划已进行了 7 次经皮 LVAD 停用手术。所有手术均成功，5 名患者仍接受药物治疗，2 名患者已进行心脏移植。经皮 LVAD 停用提供了外科取出的替代方法。经皮 LVAD 停用计划是先进心力衰竭计划的重要组成部分。
