The outcomes of a standardized protocol for extracorporeal mechanical circulatory support selection-left ventricular challenge protocol.

IF 1.1 4区 医学 Q4 ENGINEERING, BIOMEDICAL
Journal of Artificial Organs Pub Date : 2024-12-01 Epub Date: 2024-01-08 DOI:10.1007/s10047-023-01427-7
Naoki Tadokoro, Tetsuya Koyamoto, Kohei Tonai, Yuki Yoshida, Koudai Hirahsima, Satoshi Kainuma, Naonori Kawamoto, Kimito Minami, Hiroshi Nishioka, Tsukamoto Yasumasa, Tomoyuki Fujita, Satsuki Fukushima
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引用次数: 0

Abstract

There are no criteria for surgical mechanical circulatory system (MCS) selection for acute heart failure. Since 2021, we have utilized cardiopulmonary bypass system to assess patients' heart and lung condition to inform surgical MCS selection. we aimed to retrospectively analyze the outcomes of treatments administered using our protocol. We analyzed the data of 19 patients who underwent surgical MCS implantation. We compared patients' characteristics across the biventricular-assist device (BiVAD), central Y-Y extracorporeal membrane oxygenation (ECMO), central ECMO, and left VAD (LVAD) systems. Patients' diagnoses included fulminant myocarditis (47.4%), dilated cardiomyopathy (21.1%), acute myocardial infarction (15.8%), infarction from aortic dissection (5.3%), doxorubicin-related cardiomyopathy (5.3%), and tachycardia-induced myocarditis (5.3%). Eight patients (42.1%) underwent LVAD implantation, 1 (5.2%) underwent central ECMO, 4 (21.1%) underwent BiVAD implantation, and 6 (31.6%) underwent central Y-Y ECMO. 48 h after surgery, both the pulmonary arterial and right atrial pressures were effectively controlled, with median values being 19.0 mmHg and 9.0 mmHg, respectively. No patients transitioned from LVAD to BiVAD in the delayed period. Cerebrovascular events occurred in 21.1%. Successful weaning was achieved in 11 patients (57.9%), and 5 patients (26.3%) were converted to durable LVAD. Two-year cumulative survival was 84.2%. Our protocol showed good results for device selection in patients with heart failure, and device selection according to this protocol enabled good control of the pulmonary and systemic circulations.

Abstract Image

体外机械循环支持选择标准化方案-左心室挑战方案的成果。
目前还没有针对急性心力衰竭选择外科机械循环系统(MCS)的标准。自 2021 年以来,我们利用心肺旁路系统评估患者的心肺状况,为手术选择机械循环系统提供依据。我们旨在回顾性分析采用我们的方案进行治疗的结果。我们分析了 19 名接受外科 MCS 植入术的患者的数据。我们比较了双心室辅助装置 (BiVAD)、中心 Y-Y 体外膜肺氧合 (ECMO)、中心 ECMO 和左侧 VAD (LVAD) 系统的患者特征。患者的诊断包括暴发性心肌炎(47.4%)、扩张型心肌病(21.1%)、急性心肌梗死(15.8%)、主动脉夹层梗死(5.3%)、多柔比星相关心肌病(5.3%)和心动过速诱发的心肌炎(5.3%)。8 名患者(42.1%)接受了 LVAD 植入术,1 名患者(5.2%)接受了中心 ECMO,4 名患者(21.1%)接受了 BiVAD 植入术,6 名患者(31.6%)接受了中心 Y-Y ECMO。术后 48 小时,肺动脉压和右心房压均得到有效控制,中位值分别为 19.0 mmHg 和 9.0 mmHg。在延迟期,没有患者从 LVAD 过渡到 BiVAD。21.1%的患者发生了脑血管事件。11名患者(57.9%)成功断流,5名患者(26.3%)转为耐用LVAD。两年累计存活率为 84.2%。我们的方案在心衰患者的设备选择方面取得了良好的效果,根据该方案选择设备能够很好地控制肺循环和全身循环。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Artificial Organs
Journal of Artificial Organs 医学-工程:生物医学
CiteScore
2.80
自引率
15.40%
发文量
68
审稿时长
6-12 weeks
期刊介绍: The aim of the Journal of Artificial Organs is to introduce to colleagues worldwide a broad spectrum of important new achievements in the field of artificial organs, ranging from fundamental research to clinical applications. The scope of the Journal of Artificial Organs encompasses but is not restricted to blood purification, cardiovascular intervention, biomaterials, and artificial metabolic organs. Additionally, the journal will cover technical and industrial innovations. Membership in the Japanese Society for Artificial Organs is not a prerequisite for submission.
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