Arabía F A, Copeland J G, Smith R G, Banchy M, Sethi G K, Foy B, Kormos R, Tector A, Long J, Dembitsky W, Carrier M, Keon W, Pavie A, Duveau D
Section of Cardiovascular and Thoracic Surgery, University of Arizona Health Science Center, Tucson 85724-5071, USA.
ASAIO J. 1998 Sep-Oct;44(5):M336-9. doi: 10.1097/00002480-199809000-00003.
The CardioWest total artificial heart is a pneumatically driven device that totally replaces the failing ventricles. It is currently used as a bridge to heart transplantation in selected centers in the United States under a study by the Food and Drug Administration. Twenty-seven patients have undergone placement of the total artificial heart since 1993 with the intention to bridge to transplantation. Inclusion criteria included candidacy for heart transplantation, cardiac index (CI) < 2.0 L/min/m2, and maximal inotropic support. The population consisted of 25 men and 2 women of mean +/- SD age 46.5 +/- 10.3 years, body surface area 2.01 +/- 0.17 m2, and duration of implant 52 +/- 42 days. Initial diagnosis included ischemic cardiomyopathy (n = 10), idiopathic (n = 10), viral (n = 4), valvular (n = 2), and graft failure (n = 1). Infectious complications were defined as systemic (evidence of leukocytosis or fever) or local. The population experienced 64 infections (range, 0-9 per patient): 45 systemic and 19 local. Three patients did not experience any infection. Twenty-five patients reached transplantation, and were discharged home for a survival rate of 92.6%. Two patients died during the bridge, one because of mechanical failure, and one because of infection (mediastinitis). Therefore, death attributable to infections occurred in 3.7%. Previous reports of the total artificial heart experience in the late 1980s described death rates as high as 40%. Although infectious complications are common in patients who are bridged to heart transplantation with the total artificial heart, mortality from infections is 10 times less than previously reported. This may be the result of a better strategy for bridging to transplantation that includes patient selection, mobilization, early central line removal, and waiting until all possible infections are resolved before proceeding to transplantation.
CardioWest全人工心脏是一种气动驱动装置，可完全替代衰竭的心室。目前，在美国食品药品监督管理局的一项研究下，它在部分选定的中心被用作心脏移植的过渡手段。自1993年以来，已有27例患者接受了全人工心脏植入，目的是过渡到心脏移植。纳入标准包括符合心脏移植条件、心脏指数（CI）<2.0L/（min·m²）以及最大程度的正性肌力支持。研究人群包括25名男性和2名女性，平均年龄±标准差为46.5±10.3岁，体表面积为2.01±0.17m²，植入时间为52±42天。初始诊断包括缺血性心肌病（n = 10）、特发性心肌病（n = 10）、病毒性心肌病（n = 4）、瓣膜性心脏病（n = 2）和移植物衰竭（n = 1）。感染并发症分为全身性（白细胞增多或发热的证据）或局部性。该人群共经历了64次感染（范围为每位患者0 - 9次）：45次全身性感染和19次局部感染。3例患者未发生任何感染。25例患者成功接受了心脏移植，并出院回家，生存率为92.6%。2例患者在过渡期间死亡，1例死于机械故障，1例死于感染（纵隔炎）。因此，感染导致的死亡率为3.7%。20世纪80年代后期关于全人工心脏应用经验的先前报道称死亡率高达40%。尽管使用全人工心脏过渡到心脏移植的患者中感染并发症很常见，但感染导致的死亡率比先前报道低10倍。这可能是由于采用了更好的过渡到移植的策略，包括患者选择、活动、早期拔除中心静脉导管以及在进行移植前等待所有可能的感染得到解决。
