Wudel J H, Hlozek C C, Smedira N G, McCarthy P M
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195-0002, USA.
ASAIO J. 1997 Sep-Oct;43(5):M441-3.
Extracorporeal life support (ECLS) is indicated following left ventricular assist device (LVAD) implant for right heart failure or pulmonary dysfunction. From December 1991 to December 1996, 100 patients were supported with the implantable HeartMate LVAD. Of these, 12 patients were supported with ECLS post LVAD implant. Pre-operatively, 10 patients (83%) were on an intra-aortic balloon pump, 9 patients (75%) were intubated, and 8 patients (67%) required ECLS bridge to LVAD implant. Six patients (50%) were men, and patient age ranged from 28 to 63 years (mean 46 +/- 10 years). Duration of ECLS averaged 3 +/- 2 days (range, 1-9 days). Eight patients (67%) required a right ventricular assist device (RVAD) with an ECLS circuit, three patients (25%) required peripheral veno-venous ECLS, and one patient peripheral veno-arterial ECLS. Forty-five percent supported with ECLS post LVAD survived to transplant compared with the 81% supported with LVAD only. Early in this experience, three patients had RVAD support only and all three patients died. RVAD support (with or without ECLS) was 11% overall and declined from 14% in the first 50 patients to 8% in the second 50. ECLS post LVAD is relatively uncommon and its use is associated with reduced survival, but helps salvage these critically ill patients.
在植入左心室辅助装置（LVAD）后，若出现右心衰竭或肺功能障碍，则需使用体外生命支持（ECLS）。1991年12月至1996年12月期间，100例患者接受了可植入式HeartMate LVAD支持治疗。其中，12例患者在LVAD植入后接受了ECLS支持。术前，10例患者（83%）使用了主动脉内球囊泵，9例患者（75%）进行了气管插管，8例患者（67%）需要ECLS作为LVAD植入的过渡治疗。6例患者（50%）为男性，患者年龄在28至63岁之间（平均46±10岁）。ECLS的持续时间平均为3±2天（范围为1至9天）。8例患者（67%）在ECLS回路中需要右心室辅助装置（RVAD），3例患者（25%）需要外周静脉-静脉ECLS，1例患者需要外周静脉-动脉ECLS。LVAD植入后接受ECLS支持的患者中，45%存活至移植，而仅接受LVAD支持的患者存活率为81%。在这项经验的早期，3例患者仅接受了RVAD支持，且这3例患者均死亡。RVAD支持（无论是否联合ECLS）总体比例为11%，并从前50例患者中的14%降至后50例患者中的8%。LVAD植入后使用ECLS相对不常见，其使用与生存率降低相关，但有助于挽救这些重症患者。
