Oishi Hideo, Morimoto Ryota, Ito Ryota, Kazama Shingo, Kimura Yuki, Araki Takashi, Mizutani Takashi, Kuwayama Tasuku, Hiraiwa Hiroaki, Kondo Toru, Okumura Takahiro, Mutsuga Masato, Usui Akihiko, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Artif Organs. 2023 Mar;26(1):79-83. doi: 10.1007/s10047-022-01337-0. Epub 2022 May 16.
The Impella 5.0 is an axial-flow percutaneous ventricular assist device used in patients with cardiogenic shock. Although the recommended period of use is 10 days or less, weaning can be delayed because of ongoing hemodynamic instability. In clinical practice, this device sometimes malfunctions during long-term management with heparin and must be replaced; however, the relationship between the duration of support with the initial and replacement Impella 5.0 and the changes in value of the purge system has not been fully elucidated. From July 2018 to May 2021, Impella 5.0 was implanted and used for more than 10 days in 11 patients at our institution. Four patients required Impella replacement because of device malfunction and the second Impella had purge system malfunction in all cases. The second Impella was used for a significantly shorter time than the first Impella (p = 0016). We calculated the ratio of purge pressure to purge flow rate and found that the ratio exceeded 50 mm Hg/mL/h in all cases with purge system malfunction. In conclusion, it is important to construct a treatment strategy considering the duration of use, because the risk of purge system malfunction is high after replaced Impella 5.0.
Impella 5.0是一种用于心源性休克患者的轴流式经皮心室辅助装置。尽管推荐使用期限为10天或更短，但由于血流动力学持续不稳定，撤机可能会延迟。在临床实践中，该装置在长期肝素治疗期间有时会发生故障，必须进行更换；然而，最初的Impella 5.0和更换后的Impella 5.0的支持持续时间与冲洗系统值的变化之间的关系尚未完全阐明。2018年7月至2021年5月，我院11例患者植入Impella 5.0并使用超过10天。4例患者因装置故障需要更换Impella，所有病例中第二个Impella均出现冲洗系统故障。第二个Impella的使用时间明显短于第一个Impella（p = 0.016）。我们计算了冲洗压力与冲洗流速的比值，发现所有冲洗系统故障的病例中该比值均超过50 mmHg/mL/h。总之，考虑使用持续时间构建治疗策略很重要，因为更换Impella 5.0后冲洗系统故障的风险很高。
