Deleuze P H, Le Besnerais P, Mazzucotellu J P, Abe Y, Miyama M, Mourtada A, Benvenuti C, Loisance D Y
Department of Cardiothoracic Surgery, Association Claude Bernard, C.H.U. Henri Mondor, Créteil, France.
ASAIO J. 1994 Jul-Sep;40(3):M325-8. doi: 10.1097/00002480-199407000-00017.
The Nippon-Zeon (NZ) ventricular assist device is a sac type, air driven, heterotopic, external pump. Its performance has been evaluated in Japan as a bridge to myocardial recovery. Few data are available on the device as a bridge to heart transplantation. Since 1991, 10 patients (9 men) were bridged to heart transplantation with NZ, all in biventricular support. The mean age was 39 +/- 13 years (range, 21-60 years), mean body weight was 75 +/- 13 kg (range, 51-95 kg). Five patients had a dilated cardiopathy, and five were ischemic (three acute myocardial infarctions). Despite maximal inotropic support, including enoximone in seven, epinephrine in three, and intraaortic balloon pumping in one, eight patients were anuric, three were in acute hepatic failure, and three were intubated. Preoperative hemodynamic and biologic values were: cardiac index, 1.57 +/- 0.4 l/min/m2; pulmonary capillary wedge pressure, 34 +/- 5 mmHg; creatinine, 200 +/- 80 mumol/l; blood urea nitrogen, 17.5 +/- 8 mmol/l; total bilirubin 36 +/- 6 mumol/l; aspartate aminotransferase, 1,000 +/- 2,000 IU/l. In all patients, a biventricular assist device was implanted without the use of cardiopulmonary bypass. Improvement occurred immediately in all but one. Mean left ventricular flow was 4.5 +/- 0.8 l/min. Anticoagulation was maintained with intravenous heparin. Recently for bleeding was required in one case (10%), and two patients had positive blood cultures that were successfully treated. There was no mechanical failure. Hemolysis was not significant (lactate dehydrogenase, 378 +/- 50 IU/l; plasma-free hemoglobin below 10 mg/dl). Each device was free of thrombi and deposits at time of explantation. One patient died while on assist. Nine patients (90%) were transplanted after 11 +/- 8 days (range, 1-32 days). Three died early after transplantation, one of graft failure, two of sepsis. Six patients (66%) could be discharged. The follow-up ranges from 7 to 28 months. NZ is a simple, reliable, pneumatic device driven by a light, silent console; it can be rapidly implanted without cardiopulmonary bypass in patients in desperate condition who are awaiting cardiac transplantation. The difficulty of patient rehabilitation while using this device should limit the duration of support to weeks to allow the patient to be in optimal condition for heart transplantation.
日本帝人（NZ）心室辅助装置是一种囊式、气动、异位、体外泵。在日本，其性能已作为心肌恢复的桥梁进行了评估。关于该装置作为心脏移植桥梁的数据很少。自1991年以来，10例患者（9名男性）使用NZ作为心脏移植的桥梁，均为双心室支持。平均年龄为39±13岁（范围21 - 60岁），平均体重为75±13千克（范围51 - 95千克）。5例患者患有扩张型心肌病，5例为缺血性（3例急性心肌梗死）。尽管给予了最大程度的正性肌力支持，包括7例使用依诺昔酮、3例使用肾上腺素、1例使用主动脉内球囊反搏，但8例患者无尿，3例出现急性肝功能衰竭，3例需要插管。术前血流动力学和生物学指标为：心脏指数1.57±0.4升/分钟/平方米；肺毛细血管楔压34±5毫米汞柱；肌酐200±80微摩尔/升；血尿素氮17.5±8毫摩尔/升；总胆红素36±6微摩尔/升；天冬氨酸转氨酶1000±2000国际单位/升。所有患者均在未使用体外循环的情况下植入双心室辅助装置。除1例患者外，其他患者均立即出现改善。平均左心室血流量为4.5±0.8升/分钟。采用静脉肝素维持抗凝。最近，1例患者（10%）因出血需要处理，2例患者血培养阳性，但经治疗成功。未发生机械故障。溶血不明显（乳酸脱氢酶378±50国际单位/升；血浆游离血红蛋白低于10毫克/分升）。每台装置在取出时均无血栓和沉积物。1例患者在辅助期间死亡。9例患者（90%）在11±8天（范围1 - 32天）后接受了移植。3例患者在移植后早期死亡，1例死于移植物功能衰竭，2例死于败血症。6例患者（66%）可以出院。随访时间为7至28个月。NZ是一种简单、可靠的气动装置，由轻便、静音的控制台驱动；对于等待心脏移植的危急患者，无需体外循环即可快速植入。使用该装置时患者康复的困难应将支持时间限制在数周以内，以使患者处于心脏移植的最佳状态。
