Kutsuzawa Rieko, Tadokoro Naoki, Kainuma Satoshi, Kawamoto Naonori, Suzuki Kouta, Ikuta Ayumi, Tonai Kohei, Hirayama Masaya, Tomishima Yoshiyuki, Asaumi Yasuhide, Fukushima Satsuki
Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Kishibe-shimmachi, 6-1, Suita, Osaka, 564-8565, Japan.
J Artif Organs. 2025 Jun;28(2):266-269. doi: 10.1007/s10047-024-01469-5. Epub 2024 Aug 26.
The mortality rate in patients with heart failure complicated by cardiogenic shock following acute myocardial infarction (AMI) remains high, prompting research on mechanical circulatory support. Improved mortality rates have been reported with the early introduction of EcMELLA (Impella combined with extracorporeal membrane oxygenation, ECMO). However, clear indications for this treatment have not been established, given the associated risks and limitations related to access routes. Left ventricular thrombosis is traditionally considered a contraindication for Impella use. A 74-year-old man without specific medical history or coronary risk factors was diagnosed with Forrester IV heart failure due to cardiogenic shock complicated by AMI and left ventricular thrombosis. The patient underwent emergency coronary artery bypass surgery, intracardiac thrombus removal, and Dor surgery. Following cardiopulmonary bypass, ongoing heart failure was observed, necessitating the implementation of EcMELLA for circulatory support. Preoperative computed tomography showed that the bilateral subclavian arteries were too narrow (< 7 mm) and anatomically unsuitable for traditional access methods. Thus, we introduced a single-access EcMELLA 5.5, through which the Impella was introduced and veno-arterial-ECMO blood was delivered from a single artificial vessel anastomosed to the brachiocephalic artery. The patient was weaned off veno-arterial-ECMO and extubated on postoperative day 3. By postoperative day 14, improved cardiac function allowed for Impella removal. The patient was discharged on postoperative day 31 with improved ambulation; thereafter, the patient returned to work. Thus, the single-access EcMELLA5.5 treatment strategy combined with Dor procedure was effective in left ventricular thrombosis in patients with heart failure with cardiogenic shock complicated by AMI.
急性心肌梗死（AMI）后并发心源性休克的心力衰竭患者死亡率仍然很高，这促使人们对机械循环支持进行研究。早期引入EcMELLA（Impella与体外膜肺氧合，ECMO联合使用）已报告死亡率有所改善。然而，鉴于与通路相关的风险和局限性，该治疗的明确适应症尚未确立。传统上，左心室血栓形成被认为是使用Impella的禁忌症。一名74岁男性，无特殊病史或冠状动脉危险因素，因AMI并发心源性休克及左心室血栓形成被诊断为Forrester IV级心力衰竭。患者接受了急诊冠状动脉搭桥手术、心内血栓清除术和Dor手术。体外循环后，观察到持续存在的心力衰竭，因此需要实施EcMELLA进行循环支持。术前计算机断层扫描显示双侧锁骨下动脉过窄（<7mm），且解剖结构不适合传统的通路方法。因此，我们引入了单通路EcMELLA 5.5，通过该装置将Impella置入，并从与头臂动脉吻合的单一人工血管输送静脉-动脉-ECMO血液。患者在术后第3天撤离静脉-动脉-ECMO并拔管。到术后第14天，心脏功能改善，可移除Impella。患者于术后第31天出院，活动能力有所改善；此后，患者恢复工作。因此，单通路EcMELLA5.5治疗策略联合Dor手术对于AMI并发心源性休克的心力衰竭患者左心室血栓形成有效。
