Abdul-Rahman Toufik, Lizano-Jubert Ileana, Garg Neil, Tejerina-Marion Emilio, Awais Bukhari Syed Muhammad, Luisa Ek Ana, Wireko Andrew Awuah, Mares Adriana C, Sikora Vladyslav, Gupta Rahul
Medical Institute, Sumy State University, 40007 Sumy, Ukraine.
Department of Cardiology, Otto Von Guericke University of Magdeburg, 39120 Magdeburg, Germany.
Healthcare (Basel). 2023 Apr 11;11(8):1094. doi: 10.3390/healthcare11081094.
In the United States, about one million people are seen to visit the operating theater for cardiac surgery annually. However, nearly half of these visits result in complications such as renal, neurological, and cardiac injury of varying degrees. Historically, many mechanisms and approaches have been explored in attempts to reduce injuries associated with cardiac surgery and percutaneous procedures. Devices such as cardioplegia, mechanical circulatory support, and other methods have shown promising results in managing and preventing life-threatening cardiac-surgery-related outcomes such as heart failure and cardiogenic shock. Comparably, cardioprotective devices such as TandemHeart, Impella family devices, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) have also been proven to show significant cardioprotection through mechanical support. However, their use as interventional agents in the prevention of hemodynamic changes due to cardiac surgery or percutaneous interventions has been correlated with adverse effects. This can lead to a rebound increased risk of mortality in high-risk patients who undergo cardiac surgery. Further research is necessary to delineate and stratify patients into appropriate cardioprotective device groups. Furthermore, the use of one device over another in terms of efficacy remains controversial and further research is necessary to assess device potential in different settings. Clinical research is also needed regarding novel strategies and targets, such as transcutaneous vagus stimulation and supersaturated oxygen therapy, aimed at reducing mortality among high-risk cardiac surgery patients. This review explores the recent advances regarding the use of cardioprotective devices in patients undergoing percutaneous procedures and cardiac surgery.
在美国，每年约有100万人前往手术室进行心脏手术。然而，这些手术中近一半会导致不同程度的并发症，如肾脏、神经和心脏损伤。从历史上看，人们探索了许多机制和方法，试图减少与心脏手术和经皮手术相关的损伤。诸如心脏停搏液、机械循环支持等设备以及其他方法在管理和预防与心脏手术相关的危及生命的后果（如心力衰竭和心源性休克）方面已显示出有前景的结果。同样，诸如TandemHeart、Impella系列设备和静脉-动脉体外膜肺氧合（VA-ECMO）等心脏保护设备也已被证明通过机械支持具有显著的心脏保护作用。然而，它们作为预防心脏手术或经皮介入导致的血流动力学变化的介入剂使用与不良反应相关。这可能导致接受心脏手术的高危患者死亡率反弹增加。有必要进行进一步研究，以将患者分类并分层到合适的心脏保护设备组中。此外，就疗效而言，一种设备相对于另一种设备的使用仍存在争议，需要进一步研究以评估不同情况下设备的潜力。对于旨在降低高危心脏手术患者死亡率的新策略和靶点，如经皮迷走神经刺激和过饱和氧疗法，也需要进行临床研究。本综述探讨了在接受经皮手术和心脏手术的患者中使用心脏保护设备的最新进展。
