Successful coronary angioplasty in two patients with cardiogenic shock using the Nimbus Hemopump support device.
Successful coronary angioplasty in two patients with cardiogenic shock using the Nimbus Hemopump support device.
复制标题
使用 Nimbus 血泵支持装置成功对两名心源性休克患者进行冠状动脉成形术。
DOI：
10.1016/0002-8703(90)90217-l
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发表时间：
1990
影响因子：
4.8
通讯作者：
Nicklas,JM
中科院分区：
文献类型：
--
作者：
Lincoff,AM;Popma,JJ;Bates,ER;Deeb,GM;Bolling,SF;Meagher,JS;Kelly,AM;Wampler,RK;Nicklas,JM
当采用标准药物治疗时，心源性休克与超过75%的住院死亡率相关。冠状动脉血管成形术已被证明可以降低心肌梗死患者的死亡率，但该手术可能会因长期球囊膨胀、急性血管闭合或心律失常引起的短暂心肌缺血而复杂化。为了避免高风险血管成形术期间可能的失代偿，主动脉内球囊反搏和经皮心肺转流术已被用于帮助支持循环。2-5虽然这些装置可以提供不同程度的循环支持，但没有一种直接使左心室收缩并在整个心动周期中使心脏卸载。一种新的循环支持装置，Nimbus血液泵（Nimbus Medical Inc.，Ranch0 Cordova，CA），通过直接从心室腔中抽取血液并将其喷射到降主动脉中来使左心室减压（图1）。高达3.5 L/min的流量由以25，000 rpm旋转的阿基米德螺旋叶片螺杆产生。我们报告了两个心源性休克的病人，他们在冠状动脉成形术中成功地使用了血液泵，并发了潜在的灾难性心律失常。一名患有广泛前外侧心肌梗死的48岁男性接受组织纤溶酶原激活剂治疗，但在随后的48小时内出现进行性充血性心力衰竭和低血压。尽管给予了正性肌力支持，但血压（BP）仍为74/50 mm Hg，肺毛细血管楔压（PCWP）为37 mm Hg，心脏指数（CI）为2.3 L/min。通过手术暴露左股动脉，并通过固定在血管侧的12 mm Dacron移植物将21 F血液泵推入左心室。在血液泵支持下，BP升至96/61 mm Hg，PCWP降至11 mm Hg，CI增至3.9 L/min。
When standard medical therapy is employed, cardiogenic shock is associated with an in-hospital mortality rate in excess of 75%. Coronary angioplasty has been shown to reduce this mortality in patients following myocardial infarction,’but the procedure can be complicated by transient myocardial ischemia induced by prolonged balloon inflation, acute vessel closure, or arrhythmias. To avoid possible decompensation during high-risk angioplasty, intra-aortic balloon counterpulsation and percutaneous cardiopulmonary bypass have been used to help support the circulation. 2-5 Although these devices can provide variable degrees of circulatory support, none directly decompress the left ventricle and unload the heart throughout the cardiac cycle. A new circulatory support device, the Nimbus Hemopump (Nimbus Medical Inc., Ranch0 Cordova, Calif.), decompresses the left ventricle by withdrawing blood directly from the ventricular cavity and ejecting it into the descending aorta (Fig. 1). Flow up to 3.5 L/min is generated by an Archimedes spiral vane screw rotating at 25,000 rpm. We report two patients with cardiogenic shock who were successfully supported with the Hemopump during coronary angioplasties complicated by potentially catastrophic arrhythmias.Case No. 1. A 48-year-old man with an extensive anterolateral myocardial infraction was treated with tissue plasminogen activator, but developed progressive congestive heart failure and hypotension over the ensuing 48 hours. Despite inotropic support, the blood pressure (BP) remained 74/50 mm Hg, pulmonary capillary wedge pressure (PCWP) was 37 mm Hg, and the cardiac index (CI) was 2.3 L/min. The left femoral artery was surgically exposed and the 21F Hemopump was advanced into the left ventricle via a 12 mm Dacron graft anastomosed to the side of the vessel. With Hemopump support, BP rose to 96/61 mm Hg, PCWP fell to 11 mm Hg, and CI increased to 3.9 L/min.