McCarthy P M, Savage R M, Fraser C D, Vargo R, James K B, Goormastic M, Hobbs R E
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
J Thorac Cardiovasc Surg. 1995 Mar;109(3):409-17; discussion 417-8. doi: 10.1016/S0022-5223(95)70271-7.
To evaluate hemodynamic effectiveness and physiologic changes on the HeartMate 1000 IP left ventricular assist device (Thermo Cardiosystems, Inc., Woburn, Mass.), we studied 25 patients undergoing bridge to heart transplantation (35 to 63 years old, mean 50 years). All were receiving inotropic agents before left ventricular assist device implantation, 21 (84%) were supported with a balloon pump, and 7 (28%) were supported by extracorporeal membrane oxygenation. Six patients died, primarily of right ventricular dysfunction and multiple organ failure. Nineteen (76%) were rehabilitated, received a donor heart, and were discharged (100% survival after transplantation). Pretransplantation duration of support averaged 76 days (22 to 153 days). No thromboembolic events occurred in more than 1500 patient-days of support with only antiplatelet medications. Significant hemodynamic improvement was measured (before implantation to before explantation) in cardiac index (1.7 +/- 0.3 to 3.1 +/- 0.8 L/min per square meter; p < 0.001), left atrial pressure (23.7 +/- 7 to 9 +/- 7.5 mm Hg; p < 0.001), pulmonary artery pressure, pulmonary vascular resistance, and right ventricular volumes and ejection fraction. Both creatinine and blood urea nitrogen levels were significantly higher before implantation in patients who died while receiving support. Renal and liver function returned to normal before transplantation. We conclude that support with the HeartMate device improved hemodynamic and subsystem function before transplantation. Long-term support with the HeartMate device has a low risk of thromboemboli and makes a clinical trial of a portable HeartMate device a realistic alternative to medical therapy.
为评估HeartMate 1000 IP左心室辅助装置（美国马萨诸塞州沃本市的热控心血管系统公司）的血流动力学效果和生理变化，我们研究了25例接受心脏移植过渡治疗的患者（年龄35至63岁，平均50岁）。所有患者在植入左心室辅助装置前均接受了正性肌力药物治疗，21例（84%）曾使用球囊泵辅助，7例（28%）曾接受体外膜肺氧合支持。6例患者死亡，主要死于右心室功能障碍和多器官功能衰竭。19例（76%）康复，接受了供体心脏并出院（移植后生存率100%）。移植前的支持治疗平均持续76天（22至153天）。在超过1500患者日的支持治疗中，仅使用抗血小板药物时未发生血栓栓塞事件。测量到显著的血流动力学改善（从植入前到取出前），心脏指数（1.7±0.3至3.1±0.8升/分钟每平方米；p<0.001）、左心房压力（23.7±7至9±7.5毫米汞柱；p<0.001）、肺动脉压力、肺血管阻力以及右心室容积和射血分数均有改善。在接受支持治疗期间死亡的患者植入前肌酐和血尿素氮水平均显著更高。肾和肝功能在移植前恢复正常。我们得出结论，使用HeartMate装置进行支持治疗可改善移植前的血流动力学和子系统功能。使用HeartMate装置进行长期支持治疗血栓栓塞风险低，使得便携式HeartMate装置的临床试验成为药物治疗的一个现实替代方案。
