Schoen F J, Palmer D C, Bernhard W F, Pennington D G, Haudenschild C C, Ratliff N B, Berger R L, Golding L R, Watson J T
J Thorac Cardiovasc Surg. 1986 Dec;92(6):1071-81.
Forty-one patients, distributed among four centers, had left (33 patients), right (five), or bilateral (three) temporary ventricular assistance with textured (24) or smooth (17) surfaced diaphragm pumps, during an evaluation supported by the National Institutes of Health. Cardiac failure had occurred in 39 postoperative patients (after aorta-coronary bypass [23], valve replacement [four], both [nine], or other [three]), with total cardiopulmonary bypass time mean 306 minutes (range 69 to 600). Two patients had cardiomyopathy. Death of 35 nonsurvivors was due to myocardial necrosis (14), hemorrhage (nine), cerebrovascular accidents (three), infection (three), and other (six). Mean duration of support in all patients was 62 hours. In 16 patients (40%) whose condition improved, cardiac assist duration was mean 127 hours (range 48 to 264), compared with mean 19 hours (range 1 to 120) in 25 who did not. Of 17 patients in whom duration of support exceeded 72 hours, 15 (88%) improved, 11 were weaned, and six survived long term. Tissue examination (in 33 patients) by biopsy at pump implantation or autopsy revealed coagulation or contraction band myocyte necrosis, with or without hemorrhage, in 26 patients; of these, 10 improved and six were long-term survivors. Pump-related complications (two) included pulmonary embolism, most likely related to a cannulation site thrombus, and an aortic cannulation site infection in one patient each. This study suggests that mechanical cardiac assist may be accomplished with a low complication rate; should not necessarily be denied to patients with existing necrosis, because myocardial necrosis does not preclude improvement or survival; and frequently leads to functional myocardial recovery if patients survive early noncardiac complications, often the result of long duration of cardiopulmonary bypass.
在一项由美国国立卫生研究院支持的评估中，分布于四个中心的41例患者接受了左心室（33例）、右心室（5例）或双侧心室（3例）的临时心室辅助，使用的是表面有纹理（24例）或光滑（17例）的隔膜泵。39例术后患者出现心力衰竭（主动脉冠状动脉搭桥术后[23例]、瓣膜置换术后[4例]、两者皆有[9例]或其他情况[3例]），体外循环总时间平均为306分钟（范围69至600分钟）。2例患者患有心肌病。35例非幸存者的死亡原因包括心肌坏死（14例）、出血（9例）、脑血管意外（3例）、感染（3例）和其他原因（6例）。所有患者的平均支持时间为62小时。16例（40%）病情改善的患者，心脏辅助时间平均为127小时（范围48至264小时），而25例病情未改善患者的平均辅助时间为19小时（范围1至120小时）。在17例支持时间超过72小时的患者中，15例（88%）病情改善，11例成功撤机，6例长期存活。在泵植入时活检或尸检进行组织检查（33例患者）发现，26例患者存在凝血或收缩带心肌坏死，伴有或不伴有出血；其中10例病情改善，6例长期存活。与泵相关的并发症（2例）包括肺栓塞，最可能与插管部位血栓有关，以及1例患者出现主动脉插管部位感染。本研究表明，机械性心脏辅助可以在低并发症发生率的情况下完成；对于已有坏死的患者不一定应拒绝使用，因为心肌坏死并不排除病情改善或存活的可能；如果患者能挺过早发的非心脏并发症（通常是体外循环时间过长的结果），心脏辅助常常会导致心肌功能恢复。
