Wert Leonhard, Kempfert Jörg, Falk Volkmar, Potapov Evgenij V
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany.
Interdiscip Cardiovasc Thorac Surg. 2023 Jun 1;36(6). doi: 10.1093/icvts/ivad088.
Transaxillary implantation of a temporary microaxial left ventricular assist device in patients suffering from cardiogenic shock is an established technique. We present a 77-year-old female patient with severe mitral regurgitation. She underwent minimally invasive surgical mitral valve replacement. After an uneventful postoperative course, the patient developed acute heart failure on the 11th postoperative day. Transthoracic echocardiography revealed new onset of Takotsubo cardiomyopathy with a severely decreased left ventricular ejection fraction. Implantation of a microaxial flow pump for left ventricular decompression was scheduled. Preoperative computed tomography revealed a rectangular course of the right subclavian artery. To advance the Impella, we employed an introducer fitted over the guidewire behind the Impella device as a 'cue stick' to move the rigid part of the pump forward to overcome the kinking using a 'shuffleboard technique'. The haemodynamic situation stabilized immediately after implantation. The Impella 5.5 was successfully weaned after 6 days of support. In the event of (rectangular) kinking of the subclavian artery, the 'shuffleboard technique' can be used for the successful positioning of the pump.
经腋部植入临时微轴左心室辅助装置用于治疗心源性休克患者是一项成熟的技术。我们报告一位77岁患有严重二尖瓣反流的女性患者。她接受了微创二尖瓣置换术。术后过程顺利，但患者在术后第11天出现急性心力衰竭。经胸超声心动图显示新发Takotsubo心肌病，左心室射血分数严重降低。计划植入微轴流泵以减轻左心室压力。术前计算机断层扫描显示右锁骨下动脉走行呈矩形。为推进Impella装置，我们在Impella装置后方的导丝上套入一个导入器作为“球杆”，采用“沙狐球技术”推动泵的刚性部分向前移动以克服扭结。植入后血流动力学状况立即稳定。Impella 5.5在支持6天后成功撤机。在锁骨下动脉（呈矩形）扭结的情况下，“沙狐球技术”可用于成功定位泵。
