Jakob H, Maass D, Palzer B, Oelert H
Klinik für Herz-, Thorax- und Gefässchirurgie, Universitätskliniken Mainz.
Langenbecks Arch Chir. 1987;372:627-32. doi: 10.1007/BF01297898.
Patients with reduced left ventricular function do have an increased risk of inability to be weaned off bypass after open heart surgery despite maximal pharmacologic support and intraaortic balloon counter-pulsation. Centrifugal pumps used for extracorporeal circulatory assist can maintain a patient in low cardiac output up to days without anticoagulation. We used a centrifugal pump in 3 patients: as a left ventricular assist device (LVAD) in 2 patients and right ventricular assist device (RVAD) in 1 patient. One LVAD-patient became a long-term survivor after 20 h of assist, another was bridged successfully to an open heart procedure for 2 h after papillary muscle rupture. One RVAD patient died on the operating table due to massive tracheal bleeding probably caused by pulmonary hypertension.
尽管给予了最大程度的药物支持和主动脉内球囊反搏,左心室功能减退的患者在心脏直视手术后仍有无法脱离体外循环的风险增加。用于体外循环辅助的离心泵可在不进行抗凝的情况下使患者维持低心输出量状态长达数天。我们对3例患者使用了离心泵:2例患者作为左心室辅助装置(LVAD),1例患者作为右心室辅助装置(RVAD)。1例接受LVAD治疗的患者在辅助20小时后成为长期存活者,另1例在乳头肌破裂后成功过渡到心脏直视手术并辅助了2小时。1例接受RVAD治疗的患者因可能由肺动脉高压导致的大量气管出血死在手术台上。