心室辅助装置临床应用

心室辅助装置或人工心脏是应用机械或生物机械手段、部分或全部替代心脏的泵功能 ,是治疗终末期心脏病的重要手段之一 ,或作为心脏移植前的过渡治疗。 2 0 0 1年 1月我们完成 1例体外植入式心室辅助装置“ｂｅｒｌｉｎＨｅａｒｔ”(德国Ｍｅｄｉｐｏｒｔ公司 )治疗终末期扩张性心肌病病例 ,效果良好 ,现报道如下。临床资料　病人　女 ,34岁。反复胸闷、心悸、气促 7个月 ,伴腹胀、下肢水肿 4个月。曾予地高辛、双氢克尿塞 ,安体舒通、氨力农等药物治疗 ,症状持续加重。查体 :颈静脉怒张 ,双下肺少许湿罗音 ,心界两侧扩大 ,频繁早搏 ,二尖瓣…     

左心辅助循环装置植入术手术配合

总结1例左心辅助装置植入术的手术配合要点，即做好术前准备，术中严密监测左心辅助装置工作参数、密切观察病人生命体征及血流动力学变化、预防血栓形成、出血和感染，是手术成功的关键。     

心室辅助装置新进展CSCD

心脏移植是治疗严重心力衰竭的主要手段,患者术后生存率和生活质量均有提高.由于供体短缺,心脏移植手术量无明显增加.左心辅助装置可用于心脏移植过渡、终点治疗以及心肌恢复治疗.对于老年患者,左心辅助装置常可替代心脏移植.本文对心室辅助装置治疗心力衰竭效果、争论问题及展望作一综述.     

心室辅助装置应用现状及进展

心脏移植是目前终末期心力衰竭最有效的治疗手段,但供者短缺问题日益严峻。近年来,快速发展的机械循环支持技术为终末期心力衰竭患者提供了多种治疗选择。心室辅助装置（VAD）作为一种重要的机械循环支持,根据辅助时长可分为持久VAD（dVAD）和临时VAD（tVAD）,其中dVAD在桥接心脏移植、终点治疗、为临床决策争取时间方面展现了良好的应用价值。随着技术的进步和临床应用经验的积累,VAD朝着更具生物相容性、更轻量化、更仿生、更智能的方向发展。本文主要对VAD发展历程、国内外应用现状及笔者单位VAD整体应用情况进行综述,以期为促进我国VAD的临床应用提供参考。     

长期植入式心室辅助装置成功救治急性心梗心源性休克合并心包填塞1例

目的 探讨长期可植入式心室辅助救治急性心梗难治性心源性休克的可行性经验。方法 中国医学科学院阜外医院深圳医院2019年11月对1例急性心梗心源性休克合并心包填塞进行卵圆孔未闭修补术、冠状动脉旁路移植术和心室辅助装置CH-VAD血泵植入术治疗,术后早期观察血流动力学和器官灌注监测指标。出院后长期随访,应用经胸超声心动图、NYHA心功能分级、6分钟步行距离、心肺运动试验来评估心脏和活动耐量康复过程。结果 术中切开心包后有暗红色血性心包积液150 ml,左心室心尖部显著变薄,周围组织水肿,3点位置有陈旧性血栓形成。手术体外循环时间为120 min,主动脉阻断时间为55 min,主动脉侧壁阻断时间为10 min。术后早期CH-VAD血泵转速在2500～2900 r/min调整,流量为3.5～4.5 L/min,有创平均动脉压为65～75 mm Hg (1 mm Hg=0.133 k Pa),血乳酸、c Tn I和c Tn T分别术后当天和第7天恢复至正常水平。术后26 h拔除气管插管,术后第7～15天出现反复短阵室速和室颤,期间反复非同步除颤100～200 J,术后第8天再次气管插管,术后90...     

心室辅助装置的发展与临床应用

心力衰竭是严重威胁人类生命的疾病,当传统的药物治疗有一定局限性,不能达到满意疗效,心脏移植又面临供体缺乏,术后排斥反应等困难的时候,心室辅助装置(ventricular assist device,VAD)的作用就显得异常重要。VAD是应用机械或生物机械手段、部分或全部替代心脏的泵功能。自上个世纪60年代在临床应用以来,经过多年研究和临床应用,VAD的应用已从心血管手术后复苏、心脏移植过渡或替代,拓展至心肌功能的恢复乃至心力衰竭的永久性治疗。未来随着VAD发展的小型化、高功效、低噪音、低耗能、并发症少、无线能量传输和便于植入等特点,终将成为治疗终末期心力衰竭的主要手段之一。现对VAD的发展历史、临床应用、目前存在的问题以及未来发展趋势等进行综述。     

心室辅助装置的临床应用

心室辅助装置（ＶＡＤ）是用来部分或全部替代心脏的泵血功能，维持良好全身循环状态的机械装置。其目的是〔１〕：改善心脏功能不全病人的循环状态，维持全身组织的正常循环；减轻心脏的前后负荷及降低心肌的耗氧量；提高舒张期血压，增加冠脉血流，促进侧支循环的同时改...     

介入式心室辅助装置的发展历程

介入式心室辅助装置（percutaneous ventricular assist device,PVAD）作为一种微创化治疗手段,可以替代衰竭心脏的功能,为复杂冠状动脉粥样硬化性心脏病、急性心肌梗死合并心源性休克、慢性心力衰竭急性失代偿等心血管急危重症患者提供循环支持。PVAD的发展从Hemopump的崛起到Impella的繁荣,越来越多地用于血流动力学支持从而改善预后。本文将对PVAD的发展历程及临床应用进行综述。     

心室辅助循环后心肌间质变化的研究进展

心室辅助使心室处于无负荷状态,改善缺血心脏血流动力学及能量代谢状况,不仅使心力衰竭引起的多器官功能衰竭得到改善,还使心脏功能及心肌细胞的损伤得到恢复。近年来通过对心肌间质的研究发现,心室辅助循环对心肌间质中的主要结构蛋白-型、型胶原及其代谢调节系统产生影响,使心肌间质胶原含量及分布发生变化,从而逆转不利的心肌间质重构,改善心功能。现就这一主题的相关研究进行综述。     

Postoperative management of patients undergoing left ventricular assist device implantation

Left ventricular assist devices (LVAD) have become an important option for the treatment of patients with advanced heart failure. Unfortunately, patients undergoing LVAD-implantation still experience considerable perioperative morbidity and mortality. Right ventricular failure, bleeding, infections and device-associated problems represent the major postoperative complications. The present overview summarizes current strategies for preoperative risk estimation and for the prevention and treatment of frequently occurring perioperative complications.     

左心室辅助装置人工心脏植入患者的围术期护理

报告1例左心室辅助人工心脏植入术的围手术期护理经验。提出术前患者准备及医护人员培训,术后血流动力学监测与护理、呼吸系统管理、抗凝管理、一氧化氮治疗的护理、泵缆护理、功能康复训练及控制器自我管理是其护理要点。     

Preexisting mitral valve prosthesis in patients undergoing left ventricular assist device implantation

Experience with patients undergoing left ventricular assist device (LVAD) implantation with preexisting mitral valve prostheses is limited. Patients with mechanical heart valves might have an increased risk of thromboembolism; in patients with biologic valves, there might be a risk of structural deterioration of the leaflets. Out of 597 patients supported with a LVAD system between 2000 and 2009, 18 patients had mitral valve surgery prior to implantation. We excluded all patients below 18 years of age, those with postcardiotomy failure, and patients who had had mitral valve reconstruction. Only 1% of the studied patient population (n= 6) had mitral valve replacement. The mitral valve implantation has been performed 7.4 ± 9.4 years prior to LVAD insertion. None of the valves (one biologic, five mechanical) were exchanged or explanted. LVAD implantation was done either with left lateral thoracotomy (n= 5) or with midline resternotomy (n= 1). Temporary right ventricular assist device support was necessary in one case (16.6%); 30-day mortality was 16.6% (n= 1). Median support time was 14 ± 15 months. Two patients received heart transplantation after 6 and 26 months on the device; four patients died on mechanical circulatory support after 1, 2, 5, and 40 months. No valve or pump thrombosis or other clinically relevant thromboembolic events were observed. Only a small number of patients (1%) had a preexisting mitral valve prosthesis prior to LVAD implantation. No severe adverse events were observed when the prosthesis was left in place. Attention should be paid to the anticoagulation regime.     

Intraoperative left atrium inversion after implantation of HeartMate III ventricular assist device

We report here a case of left atrium inversion after implanting HeartMate III LVAD, which is known to be the first in literature. LVAD can be functional only if there is adequate inflow to the device. Parameters and filling of left ventricle can be assessed by TEE. In our case, initial examination with TEE showed thrombus like images. HeartMate III has a reliable algorithm that automatically reduces pump speed if ‘suction effect’ is detected. HeartMate III demonstrates clean flow properties and good surface wash. Despite these positive features of the HeartMate III, left atrium inversion can still be seen with it, so users should be alert in this regard.     

Intraoperative transoesophageal echocardiography for implantation of a pulsatile left ventricular assist device

We describe the insertion of a permanent implantable left ventricular assist device and intraoperative transoesophageal echocardiography in this instance. We also review the literature on the use of intraoperative transoesophageal echocardiography.      

Anesthetic management of patients undergoing implantation of left ventricular assist system]

We examined the anesthetic management of six patients with end-stage dilated and hypertrophic cardiomyopathy for implantation of left ventricular assist system. Although anesthesia was induced only with fentanyl or with combination of fentanyl and diazepam, hemodynamic changes after the anesthetic induction were variable and preoperative evaluation of left ventricular ejection fraction did not predict the hemodynamic changes. After the weaning from cardiopulmonary bypass, the right ventricular support by catecholamines, such as dopamine and dobutamine, and phosphodiesterase III inhibitors, such as amrinone, and pulmonary vasodilation by inhalation of nitric oxide were useful to maintain volume loading to the left ventricular assist system.