左心室辅助装置应用进展

在严重的左心功能不全患者,左心室辅助装置可以提供部分或完全的循环支持,但传统的左心室辅助装置需外科手术置入。目前临床有2种运用比较成熟的经皮左心室辅助装置,Tandem Heart和Impella系统．虽然它们可以改善血流动力学,但临床效果需要进一步研究,本文就其作用机制和临床使用情况作一综述。     

左心室辅助装置应用进展

在严重的左心功能不全患者,左心室辅助装置可以提供部分或完全的循环支持,但传统的左心室辅助装置需外科手术置入.目前临床有2种运用比较成熟的经皮左心室辅助装置.Tandem Heart和Impella系统,虽然它们可以改善血流动力学,但临床效果需要进一步研究,本文就其作用机制和临床使用情况作一综述.     

经皮左心室辅助装置

在严重的左心功能不全患者,左心室辅助装置可以提供部分或完全的循环支持,目前临床有两种运用比较成熟的经皮左心室辅助装置,虽然可以改善血流动力学,但临床效果需要进一步研究,现就其作用机理和临床使用情况做一综述。     

小儿心室辅助装置应用进展

常用的小儿机械辅助循环装置可分为体外膜式氧合(extracorporeal membrane oxygenation,ECMO)和心室辅助(ventricular assist device,VAD)两大类,心室辅助装置经历了第一代和第二代的发展,现正研制生物相容性更好、体积更小、植入式的可用于成人和小儿的第三代心室辅...     

全磁悬浮左心室辅助装置的研究进展

心脏移植是终末期心力衰竭治疗的金标准,但面临着供体短缺的问题。左心室辅助装置已成为目前终末期心力衰竭患者的重要治疗手段。出血、泵血栓形成、卒中、右心衰竭和溶血是限制左心室辅助装置治疗的关键因素,第三代全磁悬浮离心式连续流左心室辅助装置的研发,旨在克服这些并发症。近年来我国心室辅助装置发展迅速,多款设备已进入临床试验阶段。本文结合国际前沿研究进展,介绍国内外以磁悬浮为技术特点的左心室辅助装置的研究与应用现状。     

左心辅助装置对缺血性心衰犬血浆脑钠素水平的影响

目的　研究急性缺血性左心功能不全时左心辅助装置 (LVAD)对左心功能的影响和血浆脑钠素 (BNP)变化情况。方法　将 10只健康成年犬随机分为对照组 (A)和辅助组 (B) ,两组皆以主动脉 -左心房旁路方式植入左心辅助装置 ,在阻断实验犬左冠脉前降支主干 4 0min后开放血流 ,其中仅对B组实验犬进行左心辅助。监测 6h内两组实验犬平均动脉压 (MAP)、心输出量 (CO)、左室收缩末期压(LVESP)、肺毛细血管楔压 (PCWP)、左室压力一阶导数(LVdp/dt)等血流动力学指标及血浆BNP水平变化情况。结果　开放左前降支 6h后 ,对照组实验犬 :MAP(72 2± 8 11)mmHg,LVESP (88 8± 5 4 )mmHg ,LVdp/dt 1839± 176 ,PCWP(9 6 8± 1 4 1)mmHg ,CO(0 98± 0 13)L/min ,BNP(15 3± 7 13)pg/mL。经过 6h左心辅助循环 ,辅助组实验犬各项血流动力学指标明显改善 ,MAP (87± 6 0 4 )mmHg ,LVESP(12 1 6± 2 88)mmHg ,LVdp/dt 2 5 90± 12 6 ,PCWP (6 5 6±0 5 1)mmHg ,CO(1 5 2± 0 16 )L/min ,BNP(6 2 5± 3 4 7)pg/mL基本降至正常水平。血浆BNP水平基本不受血流动力学变化影响。结论　左心辅助装置对于缺血性心衰具有良好的治疗作用 ,促进了心肌功能恢复 ,明显降低血浆BNP水平 ,血浆BNP水平可以较好地反映心肌功能状态。     

左心室辅助装置的临床应用现状和展望

随着新型恒流式左心室辅助装置(LVAD)研制的进展,终末期心力衰竭的治疗窘境得到了改善.这些小巧的完全植入式心室辅助装置提高了终末期心力衰竭患者的生存率、生活能力以及生存质量.虽然LVAD的植入量逐年上升,但仍有许多难点困扰着临床医生以及患者,LVAD尚未成为所有终末期心力衰竭患者的治疗选择,需要继续研制更先进的LVA...     

左心室辅助装置抗栓治疗研究进展

左心室辅助装置(LVAD)已成为目前终末期心力衰竭患者的重要治疗策略,但LVAD植入可引起凝血-纤溶系统的异常激活,由此导致严重的出血和血栓事件成为治疗过程中最常见的并发症:因出血需要外科手术治疗的成人患者高达30%,而在儿童患者中高达50%,同时由于血栓和栓塞导致的脑卒中等不良事件也严重影响了LVAD植入患者的远期预后。为了预防凝血相关并发症,植入LVAD的儿童患者更倾向于使用埃德蒙顿方案;在成人患者中普遍应用华法林作为基础抗凝策略,但是目前各中心的抗凝强度差异较大,对是否同期接受抗血小板治疗也并未达成一致观点。本文对LVAD抗栓治疗的研究现状进行综述。     

新型左室辅助装置—Hemopump的临床应用进展

本文介绍Ｈｅｍｏｐｕｍｐ的结构、性能及临床应用情况。     

左心室辅助装置逆转心衰病理改变的分子机制研究进展

随着生活水平的提高和寿命的延长,心力衰竭在中国的发病率成逐年上升趋势。目前临床上心衰诊断一经确定,5年内的死亡率超过60％,终末期心衰患者预后更差,即使经过药物治疗,1年内的死亡率仍达75％。随着疾病进展,心脏对药物治疗的反应不断减弱,因此疾病后期,供临床医生选择的有效治疗手段十分有限,患者的生存率和生活质量受到很大影响。     

Epidemiology and Outcomes Associated With Anemia During Long-Term Support With Continuous-Flow Left Ventricular Assist Devices

BackgroundThe purpose of this study was to define the prevalence and clinical ramifications of anemia in patients implanted with a continuous-flow left ventricular assist device (CF-LVAD).Methods and ResultsPatients implanted with a CF-LVAD from January 1, 2008, to April 30, 2012, were included in this retrospective cohort study. The primary outcome was the prevalence of anemia throughout the 1st year of device support. Secondary end points included the impact of anemia on rates of readmission to hospital and mortality. Ninety-one patients were included; the prevalence of anemia 360 days after implantation was significantly reduced compared with baseline (61.4% vs 79.1%, respectively; P = .032); 65.4% of anemic patients and 34.6% of nonanemic patients were readmitted at least once (P = .067). The median number of readmissions in the anemic compared with the nonanemic group was 4 (interquartile range [IQR] 2-6) versus 1.5 (IQR 1-3), respectively (P < .001). Furthermore, among those who experienced >3 readmissions during the 1st year, 19 were anemic compared with 1 patient who was not anemic (P < .001).ConclusionsAnemia remains a prevalent condition while on CF-LVAD support and is associated with a significant increase in the number of hospital readmissions.     

A Review of Infections in Patients with Left Ventricular Assist Devices: Prevention,Diagnosis and Management

Since the advent of ventricular assist devices with smaller configurations and continuous-flow technology, survival rates for patients with end-stage heart failure have dramatically improved. While the burden of infectious complications is decreased in patients on continuous-flow ventricular assist devices compared to bulkier pulsatile-flow devices, infection remains one of the most common causes of morbidity and mortality. The majority of infections occur at the driveline exit site, beginning with a disruption or trauma to the barrier between the skin and driveline and sometimes spreading deeper. Once infections develop, they can be difficult to eradicate. Depending on the degree of infection, treatment options may include local wound care, antibiotics, or surgical treatment. Preventive strategies and careful surveillance are crucial to improve patient outcomes.     

Comparison of Percutaneous and Surgical Right Ventricular Assist Device Support After Durable Left Ventricular Assist Device Insertion

Background

Early right ventricular (RV) failure after left ventricular assist device (LVAD) implantation increases morbidity and mortality. Percutaneous right ventricular assist device (pRVAD) support is an alternative to more invasive surgical RVAD (sRVAD).

Renal Dysfunction in Patients with Left Ventricular Assist Device

Late-stage heart failure and renal dysfunction are often seen in conjunction. Cardiorenal syndrome (CRS) describes the complex interaction between the two disease states. Early literature described the pathophysiology of CRS as related only to reduced cardiac output and decreased renal perfusion. Recent literature suggests a more multifaceted mechanism. Left ventricular assist devices (LVAD), used as bridge-to-transplant and destination therapy in patients with heart failure, impact not only cardiac function but also renal function, especially in those patients with preoperative renal dysfunction. The mechanism by which LVAD implantation affects renal function is complex and understated in early literature. In this review, we discuss the pathogenesis of CRS, the impact of preoperative renal dysfunction in patients undergoing LVAD implantation, and the effect of LVAD implantation on postoperative renal function.     

超声心动图与左室辅助装置：现状、问题及未来

作为终末期心脏病的一种目的性治疗或心脏移植的过渡,左室辅助装置的临床应用在逐渐增多,其治疗终点的评价及并发症的诊断正在成为心血管医学界关注的重要问题。超声心动图在左室辅助装置评价中具有重要价值,可用于术前除外禁忌证、术中监测管道的位置并评价左室充盈和减负荷状态、术后监测低血容量、心包填塞及右心衰竭,并用以评价心肌恢复情况。     

Continuous Flow Left Ventricular Assist Devices: Shared Care Goals of Monitoring and Treating Patients

Continuous-flow left ventricular assist devices (CF-LVADs) have been clinically adopted as a long-term standard of care therapy option for patients with end-stage heart failure. For many patients, shared care between the care providers at the implanting center and care providers in the community in which the patient resides is a clinical necessity. The aims of this review are to (1) provide a rationale for the outpatient follow-up exam and surveillance testing used at our center to monitor patients supported by the HeartMate II^® CF-LVAD (Thoratec Corporation, Pleasanton, CA) and (2) provide the protocol/algorithms we use for blood pressure, driveline exit site, LVAD alarm history, surveillance blood work, and echocardiography monitoring in this patient population. In addition, we define our partnership outpatient follow-up protocol and the “shared care” specific responsibilities we use with referring health care providers to best manage many of our patients.     

Usefulness of Transesophageal Echocardiography in Diagnosing Valve Leakage of Left Ventricular Assist Device

In this case report, we present the utility of transesophageal echocardiography in the detection of two uncommon complications of left ventricular assist devices: regurgitation of the bioprosthetic valve in the inflow conduit and a tear of a Dacron conduit with hematoma formation and compression of the right ventricular free wall.     

左室辅助装置在心脏移植前的应用现状与进展

近年来左室辅助装置发展迅速,在终末期心力衰竭患者心脏移植前得到越来越多的应用,现简单介绍其发展进程,就其临床获益及获益机制方面的相关研究做一综述,并简要列出该装置的适用人群,展望其未来的发展。