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首页> 美国卫生研究院文献>Annals of Surgery >Implantable left ventricular assist devices: an evolving long-term cardiac replacement therapy.
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Implantable left ventricular assist devices: an evolving long-term cardiac replacement therapy.

机译：植入式左心室辅助装置：一种不断发展的长期心脏替代疗法。

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OBJECTIVE: The authors' 8-year experience with both inpatient and outpatient left ventricular assist device (LVAD) support is presented to show the possibilities and limitations of long-term outpatient mechanical circulatory assistance. SUMMARY BACKGROUND DATA: The limitation of suitable cardiac donors has led to the use of LVADs as a temporizing measure for patients awaiting cardiac transplantation. The success of such devices in the short and medium term as a bridge to transplantation has led to their evaluation as a long-term destination therapy for end-stage heart disease. METHODS: Between August 1990 and February 1997, 85 patients with end-stage heart disease underwent insertion of implantable LVADs. Fifty-two patients underwent pneumatic device insertion and 32 patients received a vented electric device. RESULTS: Patients were supported for a mean of 109+/-13 days for an overall survival to transplant (54) or explant (3) of 73%. Nineteen patients were discharged from the hospital on a mean of postoperative day 41+/-4 (range, 17-68) for an outpatient support time of 108+/-30 days (range, 2-466). Of 12 patients supported after postcardiotomy cardiogenic shock, 10 (82%) survived to hospital discharge. Perioperative right ventricular failure was treated in most patients with inotropic agents and inhaled nitric oxide with only six patients requiring right ventricular assist device support. Thromboembolic rate was low (0.016 events/patient-month) despite minimal or no anticoagulation in all cases. CONCLUSIONS: Left ventricular assist device support has evolved to become an outpatient therapy with excellent survival rates and an acceptable morbidity. Accordingly, wearable LVADs should be studied as permanent treatment options for patients who are not transplant candidates.
机译：目的：作者介绍了在住院和门诊左心室辅助装置（LVAD）支持方面8年的经验，以显示长期门诊机械循环辅助的可能性和局限性。摘要背景数据：合适的心脏供体的局限性导致了将LVAD用作等待心脏移植患者的临时措施。这种设备在短期和中期作为移植的桥梁的成功，导致了它们作为终末期心脏病的长期目的地疗法的评估。方法：在1990年8月至1997年2月之间，对85例终末期心脏病患者进行了植入式LVAD的植入。 52例患者接受了气动装置插入，32例患者接受了带电装置。结果：患者获得平均109 +/- 13天的支持，移植（54）或外植（3）的总生存率为73％。 19名患者在术后平均41 +/- 4天（范围17-68）出院，门诊支持时间为108 +/- 30天（范围2-466）。接受开颅手术后发生心源性休克的12名患者中，有10名（82％）存活到出院。大多数患者使用正性肌力药和吸入一氧化氮治疗围手术期右心室衰竭，只有六名患者需要右心室辅助装置支持。尽管在所有情况下抗凝作用很小或没有，但血栓栓塞发生率很低（0.016事件/患者/月）。结论：左心室辅助装置的支持已发展成为一种具有优良生存率和可接受的发病率的门诊治疗方法。因此，对于不是移植候选者的患者，应研究可穿戴式LVAD作为永久性治疗选择。

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