Recovery of natural heart function in severe heart failure patients by long term circulatory support with ventricular assist system

心室辅助系统长期循环支持恢复严重心力衰竭患者的自然心功能

• 批准号: 10470281
• 负责人: NAKATANI Takeshi
• 金额: $ 8.06万
• 依托单位: National Cardiovascular Center Research Institute
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (B)
• 财政年份: 1998
• 资助国家: 日本
• 起止时间: 1998 至 2000
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-10470281/
• 关键词: left ventricular assist system; heart transplantation; left atrial drainage; left ventricular drainage; dilated cardiomyopathy; ischemic cardiomyopathy; recovery of natural heart; 虚血性心筋症; 左室径; 僧帽弁逆流; 心筋症; 心筋細胞径; パーセント繊維化率

Extracorporeal National Cardiovascular Center type left ventricular assist systems (LVASs) were applied to 35 cardiomyopathy patients who were considered to be candidates for heart transplantation aged younger than 60 years old. Of those, 30 patients were suffered from dilated cardiomyopathy, 4 from ischemic cardiomyopathy and 1 for dilated phase of hypertrophic cardiomyopathy. Implantation of LVAS was performed when patient condition was deteriorated in spite of massive medical and/or surgical treatments. Five of 35 patients were needed right heart support due to profound right heart failure. In 30 cases with LVAS support without right heart support, initial 10 cases were implanted left atrial drainage type LVAS(LA). In recent cases, left ventricular drainage type LVAS(LV) were implanted. Mean assist duration was 165 days in LA type and was 367 days, including ongoing 8 cases, in LV type. All cases were stabilized after application of LVAS. Rehabilitation was started and administrations of beta-blockers and ACE inhibitors were performed. Natural cardiac function was tested by echocardiography periodically and weaning from LVAS was tried when natural heart function showed recovery of its function. In LA type, 3 out of 10 cases showed recovery of their natural heart function and LVASs were removed after 3-5 months support. All three cases are doing well 2.5-6.8 years after removal under outpatient clinic. In 20 LV type supports, only 4 cases showed recovery of natural heart. In one case, removal from LVAS was performed followed by reimplantation of LVAS due to acute deterioration of natural heart function. In seven cases (LA: 2, LV: 5), heart transplantation was done after 330 days supports on average. Their excised hearts showed severe destruction of myocardial tissue. Difference between LA type and LV type in effects of cardiac function and evaluation of natural heart function under LVAS support were studied.

应用国家心血管中心型左心室辅助系统(LVAS)对35例年龄在60岁以下的心肌病患者进行心脏移植。其中扩张型心肌病30例，缺血性心肌病4例，肥厚型心肌病扩张期1例。尽管进行了大量的内科和/或外科治疗，但病情恶化时，仍需植入左冠状动脉内支架。35例患者中有5例因严重右心衰竭需要右心支持。30例无右心支持的LVAS患者，最初10例植入左房引流型LVAS(LA)。近期行左室引流型左冠状动脉(LV)植入术。LA型平均辅助时间为165d，LV型平均辅助时间为367d，其中LV型为8例。所有病例在应用LVAS后均稳定下来。开始康复，并给予β-受体阻滞剂和血管紧张素转换酶抑制剂。定期行超声心动图检测自然心功能，待自然心功能恢复时尝试撤机。LA型10例中有3例心功能恢复正常，支持3~5个月后拔除LVASs。3例患者均在门诊就诊，术后2.5~6.8年恢复良好。20例LV型支架中，仅4例心脏恢复正常。其中1例因心功能严重恶化，行左前降支摘除后再次植入左前降支。7例(LA：2例，LV：5例)平均支持330d后完成心脏移植。他们切除的心脏显示心肌组织遭到严重破坏。比较LA型和LV型在LVAS支持下对心功能的影响和评价自然心功能的差异。

项目成果

Difference of drainage of left ventricular assist system : left atrium vs left ventricle.

左心室辅助系统引流的差异：左心房与左心室。

• 发表时间: 2001
• 作者: Nakatani T;Sasako Y;Hanatani A;Kobayashi J;Bando K;Niwaya K;Tagusari O;Ono Y;Sato N;Komamura K;Miyatake K;Yagihara T;Kitamura S.
• 通讯作者: Kitamura S.

中谷武嗣: "心臓移植2例の経験"JHIF WORKSHOP移植とヘルペスウイルス感染症. 55-58 (2000)

Takeshi Nakatani：“两个心脏移植病例的经验”JHIF WORKSHOP 移植和疱疹病毒感染。

Nakatani T., et al.: "Application of ventricular assist systems for end-stage cardiomyopathy patients as bridge to heart transplant of recovery"Transplantation Proceedings. 31. 2000-2001 (1999)

Nakatani T. 等人：“心室辅助系统在终末期心肌病患者中的应用，作为心脏移植康复的桥梁”移植论文集。

Nakatani T., et al.: "Management of young potential candidates for heart transplant"Transplantation Proceedings. 31. 1963-1965 (1999)

Nakatani T. 等人：“心脏移植年轻潜在候选者的管理”移植论文集。

中谷武嗣,笹子佳門,小坂井嘉夫 他: "わが国における人工心臓と心臓移植の展望-国立循環器病センター例を中心に-" 今日の移植. VOL.11 No.3. 311-316 (1998)

Takeshi Nakatani、Yoshimon Sasago、Yoshio Kosakai 等：“日本人工心脏和心脏移植的前景 - 聚焦国家脑心血管中心的案例 -”今日移植 VOL.11 第 3 期。 1998）