Paracorporeal Artificial Heart in Postoperative Heart Failure

A pneumatically driven artificial heart with a tubular silicone rubber membrane and disc valves was used for functional heart replacement in the paracorporeal mode. A fluidic drive system allows adjustment of the heart rate, positive and negative pressures and systole/diastole ratio.
Since August, 1977, the artificial heart has been used in four patients with refractory postoperative heart failure not responding to volume loading, pH and electrolyte correction, catecholamines and intraaortic balloon pumping. Large cannulae were placed in the atria and great vessels. The ventricles were fixed on the chest paracorporeally. The assist system was used as a left heart bypass in one patient and as a biventricular bypass in three other patients. After 48–72 hours, the ventricular function recovered in three patients, permitting removal of the artificial heart. One patient died of cerebral complications six weeks later; the other two recovered completely and were released in good condition.
Profound postoperative heart failure can be completely reversed by the use of the paracorporeal artificial heart; the advantage of the system lies in the simplicity of its implantation and removal.     

原位心脏移植术后右心衰竭四例

目的为降低原位心脏移植患者术后右心衰竭的发生率,分析其术后发生右心衰竭的原因,并总结治疗经验。方法4例晚期心脏病患者行原位心脏移植,术后均发生右心衰竭。根据心导管资料及尸体检查结果,分析原位心脏移植受者的选择,并提出右心衰竭的处理方法。结果4例原位心脏移植术后发生右心衰竭患者中2例死亡;2例存活患者恢复顺利。结论右心衰竭是原位心脏移植术后近期死亡的主要原因,必须严格掌握对受者的选择。     

Analysis of Heart Rate Turbulence in Advanced Heart Failure and Heart Transplantation Patients

Objective

The objective of this study was to describe heart rate turbulence (HRT) in advanced heart failure (HF) patients and in a group of patients who underwent heart transplantation (HT).

Materials and Methods

We performed 24-hour Holter recordings in 20 patients with advanced HF referred to our hospital for HT, including 16 males of overall mean age of 44 ± 13 years and with a mean ejection fraction (EF) 21 ± 7%. An additional set of recordings was obtained in a second group of 27 patients who had already undergone HT, including of 21 males of overall mean age of 47 ± 14 years. We recorded the number of premature ventricular contractions (PVCs), mean heart rate (MHR), and 2 parameters of HRT-turbulence onset (TO) and turbulence slope (TS).

Results

Patients with HT showed a low density of premature ventricular complexes, in contrast to patients in the advanced HF group. For this reason, HRT could only be analyzed in 15 of the patients with advanced HF (66%) and in 10 of the patients who underwent HT (37%). MHR was 77 ± 10 bpm in the advanced HF group and 90 ± 10 bpm in the HT group. In both groups, TO and TS showed highly attenuated values.

Conclusions

Patients with advanced HF showed a high number of PVCs with attenuated HRT parameters, reflecting increased circulating catecholamine levels and decreased response of the autonomic nervous system. Patients who underwent HT showed elevated MHRs, a small number of PVCs, and attenuated HRT values, as corresponds to a denervated heart.     

Heart Substitution: Transplantation and Total Artificial Heart. The Texas Heart Institute Experience

Two methods of heart substitution have been used at the Texas Heart Institute: cardiac transplantation and the total artificial heart (TAH). Cardiac transplantation is an effective means of saving patients with endstage heart disease and, since the introduction of the immunosuppressive agent cyclosporine, survival has increased significantly. In a recent series from July 1982 to May 1984, 25 patients underwent cardiac transplantation at the Texas Heart Institute. Nineteen of these patients are alive, in Functional Class I, and leading normal lives. A major disadvantage of cardiac transplantation is that it cannot be used on an emergency basis for postcardiotomy patients. In this situation, TAH has been used twice (1969 and 1981) as the first stage to maintain circulation prior to subsequent cardiac transplantation. In both instances, the TAH functioned well until a satisfactory donor was found. This demonstrates the feasibility of the two-staged concept and encourages further development of cardiac prostheses.     

左心转流在心脏直视术后的应用

目的 总结左心转流抢救心脏直视术后重度低心排血量的经验。方法 5例心瓣膜置换术患者术后发生顽固性低心排血量，应用Delphin Ⅱ型离心泵，经左心房－房心泵－主动脉或股动脉建立左心转流辅助循环。结果 5例均顺利脱离左心辅助，1例因心律失常早期死亡，2例晚期分别死于右心功能不全、多器官功能衰竭，2例痊愈出院。结论 重度低心排血量患者及时果断应用左心辅助，疗效确切，防止左心转流并发症，改善术后右心功能是提高左心转流成功率的关键。     

Heart Transplantation

In Denmark we have not yet had any experience of homotransplantation of the human heart, and as far as I know this also applies to the other Scandiavian countries. We are, however, very interested in these problems and thus look forward to hearing about the experiences gained in other countries.     

Heart injuries

Operations were carried out on 32 patients with injuries to the heart and pericardium during a period of 14 years. The pericardium was injured in 7 patients. All fatal cases were brought to the clinic in the first 30 minutes after the accident. Seven patients died after operation. The late results were studied in 22 patients in follow-up periods of 12 months to 14 years. The results were excellent and good in 20 patients and satisfactory in 2 patients. Poor results were not encountered. The capacity for work was restored in 21 patients.