Department of Cardiology, University Hospitals Brussel, Jette, Belgium.
Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.
Expert Rev Med Devices. 2022 Jun;19(6):477-488. doi: 10.1080/17434440.2022.2108319. Epub 2022 Aug 3.
Despite advances in heart failure therapies and percutaneous coronary interventions, survival for cardiogenic shock remains poor. Percutaneous ventricular assist devices (pVAD) are increasingly used, but current evidence remains conflicting. The Impella is an example of such a device, based on a catheter mounted micro-axial continuous flow pump, that has been rapidly adopted in routine practice. An important aspect of postimplantation care is the prevention of complications. Hemolysis is one of the most frequent complications seen with this device.
In this review, we discuss the pathophysiology, diagnosis and treatment of hemolysis in patients supported with a pVAD. A practical algorithm for rapid identification of hemolysis and the underlying cause is presented, allowing for early treatment and prevention of further complications.
Hemolysis remains a threat to patients supported with any mechanical circulatory support device. Prevention as well as treatment demands for sufficient knowledge about the device, the optimal position, and hemodynamics. Future studies should try to clarify some of the elements that are still unclear, such as optimal anticoagulation, the location of pentoxifylline, or extracorporeal removal of free hemoglobin. This could help to optimize outcomes in clinical practice as well as future studies.
尽管心力衰竭治疗和经皮冠状动脉介入治疗取得了进展，但心源性休克的生存率仍然很低。经皮心室辅助装置（pVAD）的应用越来越多，但目前的证据仍存在矛盾。Impella 就是这样一种装置的一个例子，它基于安装在导管上的微型轴向连续流泵，已在常规实践中迅速采用。植入后的一个重要护理方面是预防并发症。溶血是该设备最常见的并发症之一。
在这篇综述中，我们讨论了接受 pVAD 支持的患者发生溶血的病理生理学、诊断和治疗。提出了一种用于快速识别溶血及其根本原因的实用算法，以便及早治疗和预防进一步的并发症。
溶血仍然是任何机械循环支持装置支持的患者的威胁。预防和治疗都需要充分了解设备、最佳位置和血液动力学。未来的研究应试图阐明一些仍不清楚的因素，如最佳抗凝、己酮可可碱的位置或游离血红蛋白的体外清除。这有助于优化临床实践和未来研究的结果。
