经皮心脏辅助装置的临床应用现状与进展

近年来,经皮心脏辅助装置在心力衰竭、急性心肌梗死、心源性休克以及行经皮冠状动脉介入治疗的高危患者的治疗方面取得了显著的进展。经皮心脏辅助装置在提供患者血流动力学支持和心肌缺血保护方面的作用得到充分地证实。现就近年的临床应用现状和进展做简要的综述。     

经皮循环辅助装置研究进展

循环辅助装置是维持泵衰竭患者血流动力学稳定的主要手段。经皮循环辅助装置避免了外科开胸手术的风险且操作简便,近年发展十分迅速。本文重点介绍几种经皮循环辅助装置的应用进展。     

主动脉内球囊反搏的临床应用与研究进展

主动脉内球囊反搏(IABP)是目前应用最广的心室辅助装置。本文就近几年IABP在临床应用与临床研究方面的最新进展、最新成果作一简要综述。     

微创循环辅助装置临床应用现状

微创循环辅助装置能避免常规心室辅助装置的开胸手术,具有创伤小、建立迅速,价格低廉等优点,近年有很大发展.本文对当前应用于临床的四种微创循环辅助装置的原理、特点、临床应用进行综述.     

主动脉内球囊反搏辅助冠状动脉内介入术对预后的影响

目的观察急性心肌梗死（AMI）合并心力衰竭患者应用主动脉球囊反搏术（IABP）辅助冠状动脉内介入术（PCI）对预后的影响。方法选取急诊人院AMI合并心力衰竭患者共计30例,其中IABP组14例,均在IABP辅助下行急诊PCI术;对照组16例,应用升压药后行急诊PCI术。比较两组患者入院时、术后3天及6个月时超声心动图及血浆肌钙蛋白（cTnI）、B型脑钠肽（BNP）水平。结果IABP组与对照组人院时左心室功能指标及血浆删、BNP水平无统计学意义（P〉0．05）,但发病3天及6个月IABP组BNP水平显著低于对照组（P〈0．05）,发病第3天IABP组血浆cTnI水平显著低于对照组（P〈0．05）。超声心动图示左心室功能指标IABP组显著优于对照组（P〈0．05）。结论I—ABP辅助PCI能显著改善AMI合并心力衰竭患者心功能及预后。     

主动脉内球囊反搏术在急性心肌梗死合并心源性休克患者冠状动脉介入术中的疗效评估

目的评价急性心肌梗死合并心源性休克患者行急诊介入治疗时常规主动脉内球囊反搏术（IABP）的可行性及有效性。方法41例在IABP支持下行急诊介入治疗的合并心源性休克的急性心肌梗死患者为治疗组,将同期行急诊介入治疗但没有行IABP支持的合并心源性休克的急性心肌梗死患者47例设为对照组 比较两组术后2周、3个月的左室功能,评价2组术后30天以及3个月的MACE事件发生率。结果IABP组患者术后2周、3个月的左室功能较对照组明显改善（43.8%±8.2%比39.4%±5.9%,45.5%±6.6%比40.6%±4.6%,P均〈0.05） 两组患者术后30天（16/41比30/47）、3个月（18/41比33/47）的MACE事件差异也有统计学意义（P均〈0.05）,其中IABP组在降低术后30天、3个月的死亡率方面尤为明显（30天16/41比对照组30/47,3个月18/41比对照组33/47,P均〈0.05）。结论对合并心源性休克的急性心肌梗死患者行急诊PCI同时采用IABP支持治疗能有效改善左室功能和减少主要心血管不良事件的发生率。     

IABP辅助经皮冠状动脉介入治疗高危冠心病患者的危险因素

目的 探讨主动脉球囊反搏(IABP)置入辅助经皮冠状动脉介入(PCI)治疗高危冠心病患者的高危因素.方法 回顾性分析2015年1月至2018年7月所有植入IABP辅助PCI治疗的高危冠心病患者172例,对比存活组与死亡组临床高危因素的差异.结果 随访中失联36例,最终入组136例.存活组合并心力衰竭(Killip 3～...     

主动脉球囊反搏在急性心肌梗死患者中的应用

主动脉内球囊反搏（Intra-aortic balloon pump,IABP）是目前广泛应用于临床的心脏辅助装置。它于1968年由Kantrowitz等[1]报道并应用于心源性休克患者的支持治疗,至今已有几十年的历史。IABP通过其气囊在心脏舒张早期充气,增加舒张期主动脉内压力,从而增加冠状动脉血流,增加心肌供氧,并通过气囊在舒张晚期快速放气,     

体外反搏的即时血流动力学效应：与主动脉球囊反搏装置的比较

同主动脉内球囊反搏的即时血流动力学相似,体外反搏尤其是增强型体外反搏的应用可以使主动脉舒张压升高、多数患者收缩压下降,左心室后负荷降低、心输出量增加,冠状动脉血流增加,改善外周循环血流,提高切应力。但体外反搏会使静脉回心血量增多。与主动脉内球囊反搏相比,体外反搏无创、使用方便、并发症少,在临床显示出一定优势。     

28例心肌梗死后室间隔穿孔介入封堵患者主动脉内球囊反搏应用分析

目的:探讨主动脉内球囊反搏(IABP)的应用对心肌梗死后室间隔穿孔介入封堵患者血流动力学的影响。方法:连续入选2017年1月-2018年12月于我科介入封堵治疗的28例心肌梗死后室间隔穿孔患者,根据是否应用IABP分为IABP组(16例)及非IABP组(12例)。对比2组患者的临床资料及术中心导管数据,探讨IABP应用对血流动力学的影响。结果:非IABP组与IABP组梗死部位存在显著差异(P=0.048),而入院时收缩压、冠状动脉病变支数、罪犯血管、是否全闭、是否合并室壁瘤、急性心肌梗死至室间隔穿孔时间、穿孔部位、穿孔大小、心肌梗死至封堵天数、手术成功率等相比较未见明显差异。IABP组主动脉舒张末期压力、左室收缩压、左室舒张末期压力及左向右分流量均较非IABP组降低(均P0.05)。2组主动脉舒张期峰值压力无显著差异(P=0.068)。结论:IABP可在不影响全身灌注的前提下,降低室间隔穿孔患者的左室后负荷,从而降低左室收缩压,减少左向右分流,进一步降低左心室前负荷,改善心功能。     

Percutaneous left ventricular support devices

Patients undergoing percutaneous coronary intervention (PCI) who have severely compromised left ventricular systolic function and complex coronary lesions including multivessel disease, left main disease, or bypass graft disease are at higher risk of adverse outcomes from hemodynamic collapse. The TandemHeart percutaneous left ventricular assist device and the Impella Recover LP 2.5 System may provide rapid circulatory support in high-risk PCI patients and in those who have cardiogenic shock. Identification of patients who are at high risk for severe hemodynamic compromise and most likely to benefit from mechanical circulatory support is crucial to derive the most benefit from this therapy. Multicenter randomized clinical trials are needed to clearly define the role of these two devices in providing circulatory support in a variety of clinical settings.     

Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives

This study evaluates the cost‐effectiveness of percutaneous cardiac assist device (pVAD) therapy in the emergent setting compared with traditional surgical hemodynamic support alternatives. Background: Previous research has demonstrated the cost‐effectiveness of pVAD hemodynamic support for patients undergoing high‐risk percutaneous coronary intervention. For patients in cardiogenic shock (CS), use of pVAD therapy has been shown to reduce length of stay (LOS). Methods: National utilization and outcome data from the 2010–2011 MedPAR and state‐sponsored all‐payer databases were collected for patients with an acute myocardial infarction complicated by CS who were treated with either a pVAD (n = 883) or with traditional surgical hemodynamic support alternatives (ECMO and extracorporeal VAD) (n = 305). Results: Discharge survival was greater with pVADs than with surgical alternatives (56% vs. 42%, P < 0.001) and was achieved with a strong trend toward reduced LOS (13.2 and 17.9 days, respectively, P = 0.055) and a significantly lower cost of the index admission ($90,929 and $144,257, respectively, P < 0.001). Cost‐effectiveness analysis based on the national data demonstrated that pVAD achieved improved outcomes at lower cost. Data were also collected for similar patients who underwent protocol‐guided pVAD therapy (using Impella 2.5) at PinnacleHealth, between 2009 and 2011 (n = 30). At this site, the survival rate increased to 60%, length of hospitalization was shortened to 6 days, and admission costs were lowered to $53,850 relative to the surgical alternatives strategy. Conclusions: For patients in CS requiring emergent hemodynamic support, pVAD therapy offers a less invasive alternative that can be deployed sooner, resulting in better outcomes, shorter LOS, lower costs and with no incremental cost, and a survival benefit when compared with traditional surgical hemodynamic support alternatives. PVAD therapy (and Impella 2.5 in particular) is emerging as a dominant strategy for this challenging patient population. © 2013 Wiley Periodicals, Inc.     

Percutaneous support devices for high risk or complicated coronary angioplasty

Indications for coronary angioplasty have expanded to include patients with unstable acute ischemic syndromes, severe multivessel coronary artery disease and impaired left ventricular function. Several mechanical approaches have been developed as adjuncts to high risk coronary angioplasty to improve patient tolerance of coronary balloon occlusion and maintain hemodynamic stability in the event of complications. These percutaneous techniques include intraaortic balloon counterpulsation, anterograde transcatheter coronary perfusion, coronary sinus retroperfusion, cardiopulmonary bypass, Hemopump left ventricular assistance and partial left heart bypass. The intraaortic balloon pump provides hemodynamic support and ameliorates ischemia by decreasing myocardial work; it may be inserted for periprocedural complications or before angioplasty in patients with ischemia or hypotension. Anterograde distal coronary artery perfusion may be accomplished passively through an autoperfusion catheter or by active pumping of oxygenated blood or fluorocarbons through the central lumen of an angioplasty catheter. Synchronized coronary sinus retroperfusion produces pulsatile blood flow via the cardiac veins to the coronary bed distal to a stenosis. Both perfusion techniques limit development of ischemic chest pain and myocardial dysfunction in patients undergoing prolonged balloon inflations. Percutaneous cardiopulmonary bypass provides complete systemic hemodynamic support which is independent of intrinsic cardiac function or rhythm and has been employed prophylactically in very high risk patients before coronary angioplasty or emergently for abrupt closure. These and newer support devices, while associated with significant complications, may ultimately improve the safety of coronary angioplasty and allow its application to those who would otherwise not be candidates for revascularization.     

Percutaneous devices for stroke prevention

The most important approaches to prevent cerebral ischemia by catheter technique are patent foramen ovale (PFO) closure in patients with a history of cryptogenic stroke and left atrial appendage (LAA) occlusion in atrial fibrillation (AF) patients. Over the past years, several new devices have been developed for these procedures. Results of randomized trials comparing device therapy, antiplatelet, or anticoagulation therapy are still not available. However, several nonrandomized studies have shown promising results. This article gives a review on the current results and techniques of the most commonly used devices as well as on new developments and approaches to catheter-based stroke prevention.     

Durable mechanical circulatory support devices

Individuals afflicted with advanced systolic heart failure who have become unresponsive to standard medical and electrical therapies are categorized as having American Heart Association stage D heart failure. The high mortality rates for medically treated stage D heart failure have not improved in the last 10 years, and patients at this advanced stage require either palliative measures or surgical management of heart failure. In recent years, surgically implanted ventricular assist devices (VADs) have become available for long-term use and are now commonly used as a therapy for advanced heart failure. The data generated from this early experience have clearly shown that VADs improve survival and quality of life in patients with advanced heart failure when implanted as a temporary measure or as long-term support. However, with a growing heart failure population, there is much work to be done to continually improve VAD technology, patient selection criteria, and postimplantation management to define the optimal role for assist devices in the management of systolic heart failure.     

Percutaneous ventricular assist devices for cardiogenic shock

Cardiogenic shock complicates up to 7% of ST-segment elevation myocardial infarctions and 2.5% of non-ST-segment elevation myocardial infarctions, with an associated mortality of 50% to 70%. Primary cardiac pump failure is followed by secondary vital organ hypoperfusion and subsequent activation of various cascade pathways, resulting in a downward spiral leading to multiple organ failure and, ultimately, death. Immediate restoration of cardiac output by means of percutaneous ventricular assist devices restores hemodynamic stability and is an important advance in the management of patients with severe left ventricular dysfunction and cardiogenic shock. This article reviews available evidence supporting the use of percutaneous ventricular assist devices in patients suffering from cardiogenic shock.     

Percutaneous cardiopulmonary support in high-risk angioplasty

Percutaneous femoro-femoral cardiopulmonary bypass, cardiopulmonary support (CPS), has a role to play in the management of the high-risk coronary angioplasty patient. This article discusses the basic principles of cardiopulmonary bypass, technique, indications, complications, and future directions of this new addition to interventional cardiology.