Iglesias-Álvarez Diego, Pathania Vikrant
Department of Cardiothoracic Anesthesia, Freeman Hospital Newcastle Upon Tyne NHS Trust, Freeman Rd, High Heaton, Newcastle upon Tyne, NE7 7DN UK.
Indian J Thorac Cardiovasc Surg. 2021 May;37(3):341-344. doi: 10.1007/s12055-020-01082-0. Epub 2021 Jan 9.
Left ventricular assist devices (LVADs) emerged as an effective therapy for the treatment of symptomatic advanced heart failure in spite of maximum tolerated optimal medical treatment. LVADs were initially conceived as a bridge to transplantation, although with the continuing donor shortage, they also serve as a definitive therapy for some patients. Careful evaluation by a multidisciplinary team and proper patient selection are key factors for good outcomes. These patients are very high-risk surgical candidates, and their survival at 1 year after implantation is estimated to be around 81%. We report a unique case of a patient who underwent LVAD implantation as a bridge to candidacy and suffered several complications related to the device. We also present our experience dealing with these complications in a field of limited evidence. This gentleman developed pump thrombosis second- ary to heparin-induced thrombocytopenia, requiring an LVAD exchange during index admission. A year after being discharged from the first episode, he developed mediastinitis, needing removal of the pump, intravenous antibiotics, and veno-arterial extra corporeal membrane oxygenation (VA-ECMO) for hemodynamic support. A new LVAD insertion was required, and the gentleman could be eventually discharged after a prolonged admission.
尽管接受了最大耐受量的最佳药物治疗，左心室辅助装置（LVADs）仍是治疗有症状的晚期心力衰竭的有效疗法。LVADs最初被设想为移植的桥梁，尽管供体持续短缺，但它们也为一些患者提供了确定性治疗。多学科团队的仔细评估和适当的患者选择是取得良好结果的关键因素。这些患者是手术风险非常高的候选人，据估计他们植入后1年的生存率约为81%。我们报告了一例独特的病例，该患者接受LVAD植入作为候选资格的桥梁，并出现了与该装置相关的多种并发症。我们还介绍了在证据有限的领域处理这些并发症的经验。这位先生因肝素诱导的血小板减少症继发泵血栓形成，在首次入院期间需要更换LVAD。首次发作出院一年后，他发生了纵隔炎，需要取出泵，静脉使用抗生素，并采用静脉-动脉体外膜肺氧合（VA-ECMO）进行血流动力学支持。需要再次植入新的LVAD，经过长时间住院后，这位先生最终得以出院。
