Jang Mi Young, Lee Jun Ho, Chung Su Ryeun, Sung Kiick, Kim Wook Sung, Cho Yang Hyun
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Chest Surg. 2023 May 5;56(3):224-227. doi: 10.5090/jcs.22.113. Epub 2023 Feb 16.
Median sternotomy is a standard surgical technique used for left ventricular assist device (LVAD) implantation. However, if sternotomy has a prohibitive surgical risk, LVAD implantation can be performed through only left thoracotomy. We managed a patient with endstage heart failure who had recently undergone coronary artery bypass grafting (CABG) elsewhere. The patient also had a deep sternal wound infection and bacteremia. Because of refractory cardiogenic shock, we performed extracorporeal membrane oxygenation (ECMO). After multiple mediastinal washouts and omental flap placement, ECMO was converted to extracorporeal LVAD (from the left ventricular apex to the descending aorta) through a left thoracotomy. The extracorporeal LVAD was maintained for 18 days and replaced by the HeartMate 3 LVAD. The patient was discharged in good condition 115 days after CABG.
正中胸骨切开术是用于植入左心室辅助装置（LVAD）的标准外科技术。然而，如果胸骨切开术存在过高的手术风险，LVAD植入可仅通过左胸切开术进行。我们治疗了一名终末期心力衰竭患者，该患者近期在其他地方接受了冠状动脉旁路移植术（CABG）。患者还患有深部胸骨伤口感染和菌血症。由于难治性心源性休克，我们进行了体外膜肺氧合（ECMO）。在多次纵隔冲洗和大网膜瓣置入后，通过左胸切开术将ECMO转换为体外LVAD（从左心室心尖至降主动脉）。体外LVAD维持了18天，随后被HeartMate 3 LVAD取代。患者在CABG术后115天状况良好出院。
