Chen J M, Levin H R, Catanese K A, Sistino J J, Landry D W, Rose E A, Oz M C
Department of Surgery, Columbia University College of Physicians & Surgeons, New York, N.Y., USA.
J Heart Lung Transplant. 1995 Jan-Feb;14(1 Pt 1):186-91.
Despite advances in the perioperative treatment of both heart transplant and left ventricular assist device recipients, right-sided circulatory failure refractory to medical management remains a major source of morbidity in the immediate postoperative period. In addition, hypervolemia is a frequent complication encountered in the treatment of these patients because of their large fluid intake requirements and relative potential for kidney failure.
Previous reports have documented the use of continuous-flow devices to support the failing right-sided circulation of patients after both left ventricular assist device insertion and orthotopic heart transplantation. However, such continuous-flow devices may carry the attendant risks of hemolysis and bleeding and may further require 24-hour monitoring by trained personnel. We report the temporary-use pulsatile Abiomed BVS 5000 right ventricular assist device and continuous arteriovenous hemodialysis in the recipient of a pulsatile TCI HeartMate 1000 IP left ventricular assist device both after left ventricular assist device implantation and after orthotopic heart transplantation.
The patient was well at 13 months follow-up.
The use of right ventricular assist devices and continuous arteriovenous hemodialysis in both transplant and left ventricular assist device recipients undoubtedly will remain important as the popularity of these two therapeutic modalities continues to grow.
尽管心脏移植和左心室辅助装置接受者的围手术期治疗取得了进展，但药物治疗难以控制的右侧循环衰竭仍然是术后早期发病的主要原因。此外，由于这些患者液体摄入量需求大且存在肾衰竭的相对可能性，高血容量是治疗中常见的并发症。
先前的报告记录了在植入左心室辅助装置和原位心脏移植后，使用连续流装置支持患者衰竭的右侧循环。然而，这种连续流装置可能伴有溶血和出血风险，并且可能进一步需要训练有素的人员进行24小时监测。我们报告了在植入搏动性TCI HeartMate 1000 IP左心室辅助装置后以及原位心脏移植后，在接受者中临时使用搏动性Abiomed BVS 5000右心室辅助装置和持续动静脉血液透析的情况。
患者在13个月的随访中情况良好。
随着这两种治疗方式的普及，在移植患者和左心室辅助装置接受者中使用右心室辅助装置和持续动静脉血液透析无疑仍将很重要。
