Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
Division of Cardiac Anesthesiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Cardiothorac Vasc Anesth. 2022 Aug;36(8 Pt B):3318-3326. doi: 10.1053/j.jvca.2022.04.010. Epub 2022 Apr 14.
Mechanical circulatory support (MCS) is used in cardiogenic shock for periprocedural hemodynamic stability in high-risk patients and to support patients with symptomatic coronary artery disease. Depending on the MCS type, oxygenation and ventilation, in addition to increasing blood pressure by augmenting blood flow, can be achieved. MCS typically follows a failure of less invasive maneuvers or intolerance to them, such as significant ventricular arrhythmia burden from inotropic support. MCS options include intra-aortic balloon pump, transvalvular percutaneous left ventricular assist devices, venoarterial extracorporeal membrane oxygenation, and surgically implanted left ventricular assist devices. The number of MCS options has increased, and this has made the decision-making process complicated. MCS decision-making is complex, even in patients without valvular pathology. The presence of aortic valve (AV) abnormalities, such as aortic stenosis, aortic insufficiency, replaced AVs, or AV masses, adds even further to the challenge of selecting the appropriate support strategy. In this narrative review, a concise review of MCS options and the special considerations for various AV pathologies are presented.
机械循环支持（MCS）用于心原性休克，以在高危患者中实现围手术期血液动力学稳定，并支持有症状的冠状动脉疾病患者。根据 MCS 类型，可以通过增加血流量来实现氧合和通气，以及增加血压。MCS 通常是在微创操作失败或不能耐受微创操作之后，例如因正性肌力支持而导致的严重室性心律失常负担。MCS 选择包括主动脉内球囊泵、经瓣膜经皮左心室辅助装置、静脉动脉体外膜氧合和手术植入左心室辅助装置。MCS 选择的数量增加了，这使得决策过程变得复杂。即使在没有瓣膜病变的患者中，MCS 决策也是复杂的。主动脉瓣（AV）异常的存在，如主动脉瓣狭窄、主动脉瓣关闭不全、置换的 AV 或 AV 肿块，进一步增加了选择适当支持策略的挑战。在这篇叙述性综述中，对 MCS 选择以及各种 AV 病变的特殊考虑因素进行了简明的回顾。
