ABIOMED RVAD and LVAD Implantation

摘要: 1)esl)itr atlcanws i n oi)vrativt, tec*lniic~ues ant1 sltill, 1)artly e\ac.erl)atrtl I)! 1)atients lwing referre(1 ior rartliac surgical procetlures at atlc aricetl stagrs of tlisease, postoperative centricular tl! sfmication is not uncommonly seen. In ul) to 10% high-risk patients in whom carc1iol)"lmonary I pass used ~ an intra-aortic halloon pun111 (L4BP) required for separation from 1)jpass. ' Because IABP will augment cardiac out1)ut 1)) only 15%some require more significant ventricular support such as froin left (L\:ADs) antl right assist tlecices (RVADs). Furthermore. excessiv e doses inotropes can he avoitled. 199%. the Food and Drug Administration (FDA) approved ABIOMED (ABIOMED, Inc, Danvers, MA) BVS 5000 Biventricular Support Sjstem postcarcliotoiny dysfunction.' The device was designed provide pulsatile weiitriculai-. ventricular, o r hiventricular (BVS) with minimal cost ininin~al complexity implantation operation. system consists single-use blood pumps that a re actuated b y pneumatic drive console. Each pump attached intravenous pole t liedside. allowing its height relative atrium lie adjusted. This facilitates gravitational control filling. (Fig I) allows unidirectional flow Hood into two chambers, filling (atrial) chamber pumping (ventricular) chamber. Two tri-leaflet Angioflex polyurethane valves seamlessly interposed on either side chamber, flow. contains smooth-surfaced hladder. As bladder fills, air surrounding it displaced console's electronics sense chainher return pressurized outside causing ejection blood. modulated rate 70 80 mllejection flows up 6 Llmin. During operation, determined position level atrium. output manually decreased during weaning, hut otherwise, controlled automatically. Since approval use. intlication~ have expanded include use selected who suffer dysfunction. wlitw recovery likely postcardiotomy shocli. failed transplantation, '.' heart failure f te LC placemvntnf' acutts in! oc-artlial infarction 4 iock . viral niyocarclitis. It h < also 1)een succeisful ly nsetl treatment intractable tachycardiax rhetuiiiatic pricartlitiz." Even wheii tlouhtful, may nsed IiritIge-to-transplantation. "'.' Patients pstcar l iotomj stJlectetl should liatl technically successful operation fail tolerate carcliol)uliiionar! bypass evidenced index Ijelow 8.0 Llminlm', central venom pr lire atrial pressure greater than 18 niin Hg, SVOL (mixed venous oxygen saturation) less 55% despite hemoglo1)in correction inotropic support. 1)e reasonable physiological age body surface area 1.3 in'. Ideally, they recognized candidates quiclily, certainly well within hours initiation cardiopulmonary hypass. Whether IAPB used, transesophageal echocartliography quite useful determining function assessing patient's need assistance. More importantly, assessment patent foramen ovale be performed. would closure prevent right-to-left shunting desaturated left-sided Contraindications renal failure, severe liver disease, metastatic cancer, uncontrolled sepsis, interstitial pulmonary hemorrhage inadequate function, hemolysis. uncontrollable hemorrhage, nervous injury. relatively straightforward implant requires I~edside adjustment. Several cannulae available insertion (see 1 Surgical Technique (ST) section). All Dacron (E.I. DuPont de Nemoiirs Co, Wilmington, DE) velour sleeve, which positioned exit site skin order improve hemostasis encourage tissue adherence ingrowth. There cannulae: malleable tip 36F right-angled 4ZF cannula lighthouse tip. arterial 42F 14-mm elastomer-coated graft distally. Plastic hullet tips provided allow passage out pericartlial cavity through subcutaneous tunnels ST). three options cannulation: dome hetween superior vrna cava