Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.
Cardiac and Cardiac Surgery Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
JACC Cardiovasc Interv. 2023 Jul 24;16(14):1707-1720. doi: 10.1016/j.jcin.2023.05.043.
Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.
经皮心室辅助装置（pVAD）的应用经验不断增加，可用性也不断提高。Impella（雅培）是一种经皮微轴、连续流、短期心室辅助装置，需要精心的植入后管理，以避免最常见的两种并发症，即出血和溶血。为了改善预后，必须采用标准化的方法来预防、检测和治疗这些并发症。溶血的风险主要受泵不稳定的影响，这是由患者或设备相关因素引起的。全面的超声心动图评估、频繁的监测和及时的干预至关重要。在 pVAD 支持期间，由于严重疾病和接触途径激活导致的促凝状态，以及多种加重出血风险的因素，导致止血平衡不稳定。预防策略和适当的管理，适应出血的影响，是至关重要的。这篇综述为医生提供了一个指南，以解决这些与设备相关的并发症，在这个危重患者中使用 pVAD 支持的患者群体。
