Improved survival rates support left ventricular assist device implantation early after myocardial infarction.
Improved survival rates support left ventricular assist device implantation early after myocardial infarction.
复制标题
存活率的提高支持心肌梗塞后早期左心室辅助装置植入。
DOI：
10.1016/s0735-1097(99)00132-1
复制
发表时间：
1998
影响因子：
24
通讯作者：
M. Oz
中科院分区：
文献类型：
--
作者：
Jonathan Chen;J. J. DeRose;J. Slater;T. Spanier;T. Dewey;Catanese Ka;M. Flannery;M. Oz
急性心肌梗死（MI）后早期植入左心室辅助装置（LVAD）传统上被认为与高死亡率相关，因为技术限制和严重的终末器官功能障碍。在一些有经验的中心，医生已经避免了早期手术后，MI允许一段时间的血流动力学和end-organ stabilization. METHODS我们回顾性调查的影响，术前MI的生存率的25例患者接受了Thermocardiosystems公司LVAD无论是<2周（早期）（n = 15）或>2周（晚期）（n = 10）后MI。结果变量包括围手术期右心室辅助（和右侧循环衰竭）、血液动力学指标、移植或再移植百分比和死亡率。早期组患者围手术期机械右心室辅助率较低，但围手术期吸入性一氧化氮使用率较高。此外，67%的患者在早期组存活到移植和7%的再灌注，结果与那些在晚期组（60%和0%分别）。CONCLUSIONSSThis临床经验表明，患者可能有可比的结果是否植入早期或晚期急性心肌梗死后。因此，这些数据支持在MI后LVAD候选者中早期识别和及时应用该模式，因为该策略也可能揭示MI后临时LVAD插入可能允许完全心室恢复的患者亚组。
OBJECTIVESImplantation of left ventricular assist devices (LVADs) early after acute myocardial infarction (MI) has traditionally been thought to be associated with high mortality rates due to technical limitations and severe end-organ dysfunction. At some experienced centers, doctors have refrained from earlier operation after MI to allow for a period of hemodynamic and end-organ stabilization.METHODSWe retrospectively investigated the effect of preoperative MI on the survival rates of 25 patients who received a Thermocardiosystems Incorporated LVAD either <2 weeks (Early) (n = 15) or >2 weeks (Late) (n = 10) after MI. Outcome variables included perioperative right ventricular assistance (and right-sided circulatory failure), hemodynamic indexes, percent transplanted or explanted, and mortality.RESULTSNo statistically significant differences were demonstrated between demographic, perioperative or hemodynamic variables between the Early and Late groups. Patients in the Early group demonstrated a lower rate of perioperative mechanical right ventricular assistance, but had a higher rate of perioperative inhaled nitric oxide use. In addition, 67% of patients in the Early group survived to transplantation and 7% to explantation, findings comparable to those in the Late group (60% and 0% respectively).CONCLUSIONSThis clinical experience suggests that patients may have comparable outcomes whether implanted early or late after acute MI. These data therefore support the early identification and timely application of this modality in post-MI LVAD candidates, as this strategy may also reveal a subgroup of patients for whom post-MI temporary LVAD insertion may allow for full ventricular recovery.