Pradegan Nicola, Lena Tea, Tessari Chiara, Gallo Michele, Tarzia Vincenzo, Guariento Alvise, Padalino Massimo, Vida Vladimiro, Gerosa Gino
Cardiac Surgery Unit, Heart Transplant and MCS Program, Cardio-thoracic-vascular and Public Health Department, Padova University Hospital, Padova, Italy.
Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky.
J Soc Cardiovasc Angiogr Interv. 2024 Mar 12;3(4):101334. doi: 10.1016/j.jscai.2024.101334. eCollection 2024 Apr.
Even if the Fontan operation is the surgical treatment of choice in patients with univentricular physiology, it remains a palliative strategy. Consequently, when Fontan patients reach adulthood, the majority of them develop late clinical sequelae of a failing cavo-pulmonary circuit (eg, liver failure, protein-losing enteropathy, and arrhythmias). Although heart transplantation represents the gold standard to treat this condition, Fontan patients usually accede to this therapy late, when risk of mortality is significantly increased, and a shortage of donor hearts limits transplantation in this special population. Mechanical circulatory support is an emerging field, but it is still in the experimental stage. Current mechanical circulatory devices have been used in Fontan circulation but are associated with the need for high-risk redo surgery. Percutaneous pumps are an emerging field that is still under investigation, with multiple prototypes developed. This review aims to analyze the hemodynamic profile of the developed intravascular pumps and their application in the preclinical scenario in the Fontan circulation.
即使Fontan手术是单心室生理患者的首选外科治疗方法，但它仍然是一种姑息性策略。因此，当Fontan患者成年时，他们中的大多数会出现腔肺循环衰竭的晚期临床后遗症（如肝衰竭、蛋白丢失性肠病和心律失常）。虽然心脏移植是治疗这种疾病的金标准，但Fontan患者通常在死亡率显著增加的晚期才接受这种治疗，而且供体心脏的短缺限制了这一特殊人群的移植。机械循环支持是一个新兴领域，但仍处于实验阶段。目前的机械循环装置已用于Fontan循环，但与高风险再次手术的需求相关。经皮泵是一个仍在研究中的新兴领域，已经开发出多种原型。本综述旨在分析已开发的血管内泵的血流动力学特征及其在Fontan循环临床前场景中的应用。
