Sakai Ai, Iino Kenji, Yamamoto Yoshitaka, Takemura Hirofumi
Department of Cardiovascular Surgery, Kanazawa University, Kanazawa, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 3;39(6). doi: 10.1093/icvts/ivae202.
Patients with low-flow, low-gradient severe aortic stenosis and ischaemic cardiomyopathy are at risk for postcardiotomy cardiogenic shock and have a poor prognosis. Although Impella has emerged as a bridge therapy, traditional approaches for Impella insertion are infeasible in patients with peripheral vascular diseases. We successfully managed postcardiotomy cardiogenic shock in a patient with low-flow, low-gradient severe aortic stenosis and ischaemic cardiomyopathy and limited vascular access by introducing Impella via the brachiocephalic artery. Impella may enable the surgical treatment of high-risk patients.
低流量、低压力阶差的重度主动脉瓣狭窄合并缺血性心肌病患者术后有发生心源性休克的风险，且预后较差。尽管Impella已成为一种过渡治疗方法，但对于患有周围血管疾病的患者，传统的Impella置入方法并不可行。我们通过经头臂动脉置入Impella，成功救治了一名低流量、低压力阶差的重度主动脉瓣狭窄合并缺血性心肌病且血管通路有限的患者的心源性休克。Impella可能使高危患者能够接受手术治疗。
