左心輔助裝置的植入及其適應(yīng)癥-孫寒松-課件幻燈（中英文）

左心輔助裝置的植入及其適應(yīng)癥孫寒松中國醫(yī)學(xué)科學(xué)院阜外心血管病醫(yī)院

中國協(xié)和醫(yī)科大學(xué) 阜外心血管病研究所心衰的流行病學(xué)人群流行病學(xué)研究顯示：中國共有447萬心衰患者北京市有5萬多心衰患者北京市心衰患者死亡率與惡性腫瘤死亡率相近心衰治療藥物治療：

?受體阻滯劑ACEI類藥物ARB類藥物藥物治療的效果有限，并沒有預(yù)想的好。心衰治療外科治療心臟移植搭橋，二尖瓣成型細(xì)胞移植心室成形機(jī)械輔助裝置臨床資料從2003年11月至今：共完成左心輔助裝置植入17例平均年齡：56.8±8.9y(39-68y)平均體重：72.3±12.6Kg(55–110Kg)臨床資料安裝時(shí)機(jī)：重癥患者選擇性安裝12例急癥搶救性安裝5例

臨床資料左室輔助裝置應(yīng)用類型

Medos

4例AB5000

1例BVS500012例插管方法1、引流管右上肺靜脈灌注管升主動(dòng)脈優(yōu)點(diǎn)：病人可活動(dòng)，適合長期輔助10例2、引流管右上肺靜脈灌注管左股動(dòng)脈優(yōu)點(diǎn)：可以床旁撤管，短期輔助7例（全為BVS）·牛頸靜脈結(jié)果支持時(shí)間：9.6±10.7d(0.5d–43d)恢復(fù)過渡應(yīng)用15例成功脫機(jī)：70.5%出院：58.8%結(jié)果移植過渡2例1例移植成功，MEDOSLVAD支持26天1例在等待移植過程中死亡，BVS5000LVAD支持43天結(jié)果主要并發(fā)癥；腦栓塞出血感染多器官功能衰竭比較

LVADsECMO

植入技術(shù)復(fù)雜簡單胸液少多輔助時(shí)間長短心或肺輔助心兩者都有費(fèi)用多少管理簡單復(fù)雜

小結(jié)適應(yīng)癥急診應(yīng)用：心衰失代償患者有猝死可能右室功能惡化心指數(shù)CI＜2L/min/㎡選擇性應(yīng)用不能脫離正性肌力藥物，LVEF<25%不適合心臟移植不能脫離體外循環(huán)機(jī)小結(jié)小結(jié)小結(jié)最重要的預(yù)后決定因素：

置入時(shí)間

患者選擇恰當(dāng)選擇恰當(dāng)?shù)难b置和置入方式謝謝!IndicationandImplantationofLVAD

SUNHANSONG

DepartmentofCardiovascularSurgery,FuWaiHospital,PUMC&CAMSBeijing,ChinaEpidemiologyofHFPopulationbasedstudieshaveshown:InChina4.47millionHFpatientsInBeijingover50thousands

ThemortalityofHFinBeijingassameasthatofmalignanttumorTherapiesMedicinetreatment:?–blockerACEIARBTheresultsarenotsogoodasexpectedSurgicaltreatmentHearttransplantationCABGMVPCelltransplantationVentriculo--plastyMCSTherapiesClinicalData(1)11,2003.~LVADs:17casesMeanage：56.8±8.9y(39-68y)Meanweight:72.3±12.6Kg(55– 110Kg)ClinicalData(2)

FuWaihospitalTimingselection

Implantedinanelectivesetting: 12casesImplantedinurgentscenario: 5cases

ClinicalData(3)PatientselectionPostcardiotomy:15casesChronicprogressiveheartfailure:2cases

TypesofLVADs

Medos

4casesAB5000

1caseBVS5000

12casesMethodsofcannulation2、OutletcannulaRightsuperiorpulmonaryveinInletlcannulaFemoralartery Advantage：de-cannulabedside,7cases(allBVS).1.OutletcannulaRightsuperiorpulmonaryveinInletcannulaAscendingaorta

Advantage:Allowpatientmobility,10cases.

ImplantTechniqueModificationModification:(forBVS5000)Inletcannula:Femoralartery

Outletcannula:Bovinejugularveinleftatrial

Advantage:1.Bedsidedecannulation,2.Preventionbleeding

Disadvantage:Limitpatientmobility

Suitable:

Short-termassistforbridgetorecoveryAvoidre–sternotomySmallincisionbelowxiphoidEasymanagement·BovinejugularveinDe-airORICUextubationOutcome(1)SupportDuration:9.6±10.7d(0.5d–43d)Bridgetorecovery:15caseSuccessfulweanrate:70.5%Successfuldischargerate:58.8%

Outcome(2)

Bridgetotransplant:2cases 1patientsgotsuccessfullytransplantation

supportedbyMEDOSLVAD(26d)

1patientwaslostwhilewaitingfordonorheart

supportedbyBVS5000LVAD(43d)

Outcome(3)

Majorcomplications:CerebralembolismBleedingInfectionMOF

Comparison

LVADsECMOImplanttechniquecomplexsimpleChestdrainagelessmoreAssistdurationlongshortHeartorlungassistheartbothCostmorelessManagementsimplecomplex

Conclusion(1)

IndicationUrgentDecompensatedhearfailureRiskforsuddendeathDeteriorationinRVfunctionCI＜2L/min/㎡ElectiveInabilitytoweanfrominotropes,LVEF25%NotatransplantcandidateInabilitytoweanfromCPBConclusion(2)TimingofImplantPostcardiotomyProlongedbypasstimemaylimitsurvival:morethan1hrProgressiveheartfailureStableconditionNormalend-organfunctionConclusion(3)SelectionofDeviceandimplantmethod:PostcardiotomyContinuoussupportminimum48hrsChronicprogressiveheartfailureIntermediatetomiddle-termdeviceAllowpatientmobilit