机械循环支持装置在心力衰竭中的应用Application of mechanical circulatory support devices in heart failure
雷雅岚,柳梅,李涵泺,李盛华,尚小珂
摘要(Abstract):
经过多年跨学科的深入研究和发展,用于辅助或替代功能衰竭心脏的机械循环支持装置(MCSD)[包括心室辅助装置(VAD)和全人工心脏(TAH)]已经在治疗晚期心力衰竭患者中确立了其重要地位,不仅为患者提供了新的生存机会,也显著改善了其生活质量。当前,患者因供体器官短缺或存在禁忌证而无法接受心脏移植手术时,机械循环支持(MCS)已成为一种公认的、长期的治疗方案。由于这些设备不受供体器官限制,具有持续的可用性,将在未来的医学中发挥更重要的作用。本文旨在综述MCSD的发展历程、适应证、分类及并发症。
关键词(KeyWords): 机械循环支持装置;心室辅助装置;全人工心脏;感染
基金项目(Foundation): 国家重点研发计划项目(2023YFC2706203);; 武汉市科技局科技成果转化重点项目(2024030803010189);; 武汉市东湖高新“揭榜挂帅”项目(2024KJB345)
作者(Author): 雷雅岚,柳梅,李涵泺,李盛华,尚小珂
参考文献(References):
- [1]Jepson BM,Mackay-Bojack S,Moller JH.The first cardiac operation using cardiopulmonary bypass[J].Ann Thorac Surg,2017,103(4):e339-e340.DOI:10.1016/j.athoracsur.2016.09.064.
- [2]Hetzer R,Hennig E.Mechanical circulatory support sy stems[M].Springer Handbook of Medical Technology.Heidelberg:Springer Berlin Heidelberg,2011:723-748.
- [3]Hess NR,Ziegler LA,Kaczorowski DJ,Heart donation and preservation:historical perspectives,current technologies,and future directions[J].J Clin Med,2022,11(19):5762.DOI:10.3390/jcm11195762.
- [4]Henn MC,Mokadam NA.Total artificial heart as a bridge to transplantation[J].Curr Opin Organ Transplant,2022,27(3):222-228.DOI:10.1097/MOT.0000000000000982.
- [5]Hetzer R,Javier MFDM,Dandel M,et al.Mechanical circulatory support systems:evolution,the systems and outlook[J].Cardiovasc Diagn Ther,2021,11(1):309-3-22.DOI:10.21037/cdt-20-283.
- [6]Bücherl ES,Hennig E.20 Jahre Kunstherzforschung in Berlin[M].Chirurgie im Wandel der Zeit 1945-1983.1983:86-108.
- [7]Pasic M,Loebe M,Hummel M,et al.Heart transplantation:a single-center experience[J].Ann Thorac Surg,1996,62(6):1685-1690.DOI:10.1016/s0003-4975(96)00815-6.
- [8]Noon GP,Morley DL,Irwin S,et al.Clinical experience with the MicroMed DeBakey ventricular assist device[J].Ann Thorac Surg,2001,71(3 Suppl):S133-S146.DOI:10.1016/s0003-4975(00)02634-5.
- [9]李平,董念国.机械循环辅助治疗心力衰竭进展[J].内科急危重症杂志,2023,29(6):441-445.D0I:10.11768/nkjwzzzz20230601.
- [10]Wrisinger WC,Thompson SL.Basics of extracorporeal membrane oxygenation[J].Surg Clin North Am,2022,102(1):23-35.DOI:10.1016/j.suc.2021.09.001.
- [11]Vieira JL,Ventura HO,Mehra MR.Mechanical circulatory support devices in advanced heart failure:2020 and beyond[J].Prog Cardiovasc Dis,2020,63(5):630-639.DOI:10.1016/j.pcad.2020.09.003.
- [12]Werdan K,Gielen S,Ebelt H,et al.Mechanical circulatory support in cardiogenic shock[J].Eur Heart J,2014,35(3):156-167.DOI:10.1093/eurheartj/eht248.
- [13]Combes A,Price S,Slutsky AS,et al.Temporary circulatory support for cardiogenic shock[J].Lancet,2020,396(10245):199-212.DOI:10.1016/S0140-6736(20)31047-3.
- [14]Hochman JS,Katz S.Back to the future in cardiogenic shockinitial PCI of the culprit lesion only[J].N Engl J Med,2017,377(25):2486-2488.DOI:10.1056/NEJMe1713341.
- [15]Ezad SM,Ryan M,Donker DW,et al.Unloading the left ventricle in venoarterial ECMO:in whom,when,and how?[J].Circulation,2023,147(16):1237-1250.DOI:10.1161/CIRCULATIONAHA.122.062371.
- [16]Allender JE,Reed BN,Foster JL,et al.Pharmacologic considerations in the management of patients receiving left ventricular percutaneous mechanical circulatory support[J].Pharmacotherapy,2017,37(10):1272-1283.DOI:10.1002/phar.1995.
- [17]Limbert VM,Amiri AM.Intra-aortic balloon pump for patients with cardiac conditions:an update on available techniques and clinical applications[J].Reports—Medical Cases Images and Videos,2019,2(3):19.DOI:10.3390/reports2030019.
- [18]陈静,吴明祥,苏晞.终末期心力衰竭机械循环支持的治疗进展[J].中国心血管杂志,2024,29(1):17-26.DOI:10.3969/j.issn.1007-5410.2024.01.005.
- [19]Chakaramakkil MJ,Sivathasan C.ECMO and short-term support for cardiogenic shock in heart failure[J].Curr Cardiol Rep,2018,20(10):87.DOI:10.1007/s11886-018-1041-4.
- [20]Ratnani I,Tuazon D,Zainab A,et al.The role and impact of extracorporeal membrane oxygenation in critical care[J].Methodist Debakey Cardiovasc J,2018,14(2):110-119.DOI:10.14797/mdcj-14-2-110.
- [21]Hette AN,Sobral MLP.Mechanical circulatory assist devices:which is the best device as bridge to heart transplantation?[J].Braz J Cardiovasc Surg,2022,37(5):737-743.DOI:10.21470/1678-9741-2021-0562.
- [22]Obradovic D,Freund A,Feistritzer HJ,et al.Temporary mechanical circulatory support in cardiogenic shock[J].Prog Cardiovasc Dis,2021,69:35-46.DOI:10.1016/j.pcad.2021.11.006.
- [23]Ouweneel DM,de Brabander J,Karami M,et al.Reallife use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction:12 years AMC experience[J].Eur Heart J Acute Cardiovasc Care,2019,8(4):338-349.DOI:10.1177/2048872618805486.
- [24]Maniuc O,Salinger T,Anders F,et al.Impella CP use in patients with non-ischaemic cardiogenic shock[J].ESC Heart Fail,2019,6(4):863-866.DOI:10.1002/ehf2.12446.
- [25]Karami M,den Uil CA,Ouweneel DM,et al.Mechanical circulatory support in cardiogenic shock from acute myocardial infarction:Impella CP/5.0 versus ECMO[J].Eur Heart J Acute Cardiovasc Care,2020,9(2):164-172.DOI:10.1177/2048872619865891.
- [26]Schiller P,Hellgren L,Vikholm P.Survival after refractory cardiogenic shock is comparable in patients with Impella and veno-arterial extraco rporeal memb rane oxygenation when adj usted for SAVE score[J].Eur Heart J Acute Cardiovasc Care,2019,8(4):329-337.DOI:10.1177/2048872618799745.
- [27]Lemor A,Hosseini Dehkordi SH,Basir MB,et al.Impella versus extracorporeal membrane oxygenation for acute myocardial infarction cardiogenic shock[J].Cardiovasc Revasc Med,2020,21(12):1465-1471.DOI:10.1016/j.carrev.2020.05.042.
- [28]McDonagh TA,Metra M,Adamo M,et al.2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure[J].Eur Heart J,2021,42(36):3599-3726.DOI:10.1093/eurheartj/ehab368.
- [29]刘周,张宏家.机械循环辅助装置研究进展[J].中国胸心血管外科临床杂志,2023,30(9):1355-1361.D0I:10.7507/1007-4848.202201028.
- [30]Molina EJ,Shah P,Kiernan MS,et al.The Society of Thoracic Surgeons Intermacs 2020 annual report[J].Ann Thorac Surg,2021,111(3):778-792.DOI:10.1016/j.athoracsur.2020.12.03 8.
- [31]Cho SM,Mehaffey JH,Meyers SL,et al.Cerebrovascular events in patients with centrifugal-flow left ventricular assist devices:propensity score-matched analysis from the Intermacs registry[J].Circulation,2021,144(10):763-772.DOI:10.1161/CIRCULATIONAHA.121.055 716D.
- [32]McNamara N,Narroway H,Williams M,et al.Contemporary outcomes of continuous-flow left ventricular assist devices-a systematic review[J].Ann Cardiothorac Surg,2021,10(2):186-208.DOI:10.21037/acs-2021-cfmcs-35.
- [33]Kirklin JK,Pagani FD,Goldstein DJ,et al.AmericanAssociation for Thoracic Surgery/International Society for Heart and Lung Transplantation guidelines on selected topics in mechanical circulatory support[J].J Thorac Cardiovasc Surg,2020,159(3):865-896.DOI:10.1016/j.jtcvs.2019.12.021.
- [34]Gurbel PA,Shah P,Desai S,et al.Antithrombotic strategies and device thrombosis[J].Cardiol Clin,2018,36(4):541-550.DOI:10.1016/j.ccl.2018.06.008.
- [35]Dandel M,Hetzer R.Evaluation of the right ventricle by echocardiography:particularities and major challenges[J].Expert Rev Cardiovasc Ther,2018,16(4):259-275.From NLM.DOI:10.1080/14779072.2018.1449646.
- [36]Dandel M,Hetzer R.Temporary assist device support for the right ventricle:pre-implant and post-implant challenges[J].Heart Fail Rev,2018,23(2):157-171.DOI:10.1007/s10741-018-9678-z.
- [37]中国医师协会心血管内科医师分会,中国医院协会心脏康复管理专业委员会.成人肺高血压患者运动康复中国专家共识[J].中国介入心脏病学杂志,2021,29(8):421-432.DOI:10.3969/j.issn.1004-8812.2021.08.001.
- [38]Johnson S,Sommer N,Cox-Flaherty K,et al.Pulmonary hypertension:a contemporary review[J].Am J Respir Crit Care Med,2023,208(5):528-548.DOI:10.1164/rccm.202302-0327SO.
- [39]Kukucka M,Potapov E,Stepanenko A,et al.Acute impact of left ventricular unloading by left ventricular assist device on the right ventricle geometry and function:effect of nitric oxide inhalation[J].J Thorac Cardiovasc Surg,2011,141(4):1009-1014.DOI:10.1016/j.jtcvs.2010.08.010.
- [40]Subramaniam K.Mechanical circulatory support[J].Best Pract Res Clin Anaesthesiol,2015,29(2):203-227.DOI:10.1016j.bpa.2015.04.003.
- [41]Jorde UP,Uriel N,Nahumi N,et al.Prevalence,significance,and management of aortic insufficiency in continuous flow left ventricular assist device recipients[J].Circ Heart Fail,2014,7(2):310-319.DOI:10.1161/CIRCHEARTFAILURE.113.000878.
- [42]D'Ancona G,Pasic M,Buz S,et al.TAVI for pure aortic valve insufficiency in a patient with a left ventricular assist device[J].Ann Thorac Surg,2012,93(4):e89-e91.DOI:10.1016/j.athoracsur.2011.11.019.
- [43]中国医师协会心血管内科医师分会结构性心脏病学组,亚太结构性心脏病俱乐部,宋光远,等.中国经导管主动脉瓣置换术临床路径专家共识(2024版)[J].中国介入心脏病学杂志,2024,32(11):601-617.DOI:10.3969/i.issn.1004-8812.2024.11.001.