From the Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
ASAIO J. 2022 Jan 1;68(1):e12-e15. doi: 10.1097/MAT.0000000000001407.
Microaxial left ventricular assist devices (mLVADs) have traditionally been placed through a transfemoral or transaxillary arterial approach. Transfemoral access is restrictive, significantly limiting postoperative patient ambulation. Transaxillary placement is preferred but not feasible in a subset of patients due to small arterial diameter or tight angulation of the thoracic outlet. Transcarotid delivery has been utilized for other cardiovascular device deployment with good success; however, this approach has not been described for mLVAD support. We present a case series of transcarotid placement of mLVADs in cases where a transaxillary and transfemoral approach was not feasible. From May 2017 to April 2019, six patients in cardiogenic shock required mLVAD support achieved via a transcarotid approach. Technical success was achieved in all patients. One patient was directly weaned from mLVAD support and two patients died on mLVAD support. Escalation to venoarterial extracorporeal membrane oxygenation (VA-ECMO) was required for three patients, two of whom subsequently died. There were no bleeding or valvular complications related to device placement, and no obvious or known neurologic complications related to mLVAD support. Transcarotid placement of mLVADs expands the utility of these devices as an alternative to traditional support strategies or prohibitive arterial anatomy; however, further study is needed to determine its efficacy.
微轴左心室辅助装置（mLVAD）传统上通过股动脉或腋动脉入路放置。股动脉入路具有局限性，极大地限制了术后患者的活动能力。由于动脉直径小或胸出口角度紧，经腋动脉放置是首选，但在一部分患者中不可行。经颈动脉输送已成功用于其他心血管设备的部署；然而，这种方法尚未用于 mLVAD 支持。我们报告了一组经颈动脉放置 mLVAD 的病例系列，这些病例经腋动脉和股动脉入路不可行。2017 年 5 月至 2019 年 4 月，6 例心源性休克患者采用经颈动脉入路实现 mLVAD 支持。所有患者均达到技术成功。1 例患者直接从 mLVAD 支持中脱机，2 例患者在 mLVAD 支持下死亡。3 例患者需要升级为静脉动脉体外膜肺氧合（VA-ECMO），其中 2 例患者随后死亡。与器械放置相关的无出血或瓣膜并发症，与 mLVAD 支持相关的无明显或已知的神经并发症。经颈动脉放置 mLVAD 扩大了这些设备的用途，可作为传统支持策略或动脉解剖学限制的替代方法；然而，需要进一步的研究来确定其疗效。
