关键词:

"> 心室辅助装置 , 急性心梗 , 心源性休克 , 血泵

Abstract:

Objective Explore the feasibility and experience of using long-term implantable ventricularassist devices to treat intractable cardiogenic shock caused by acute myocardial infarction. Methods In November 2019，the Shenzhen Hospital of Fuwai Hospital treated a case of acute myocardial infarction，cardiogenic shock，and cardiac tamponade with oval foramen repair surgery. The patient underwent coronary artery bypass grafting，and implantation of the CH-VAD ventricular assist device. Early postoperative observations included hemodynamic and organperfusion monitoring indicators. Long-term follow-up after discharge included transthoracic echocardiography，NYHAcardiac function classification，6-minute walk distance，and cardiopulmonary exercise testing to assess the recovery process of cardiac function and exercise tolerance. Results During the surgery，150 ml of dark，red，bloody pericardial effusionwas found after opening the pericardium. The apex of the left ventricle was significantly thinned，and the surrounding tissue was edematous. An old thrombus had formed at the 3 o'clock position. The cardiopulmonary bypass time was 120 min，the aortic cross-clamp time was 55 min，and the time for clamping the aortic sidewall was 10 min. Early postoperative CH-VAD pump speed was adjusted to between 2 500 and 2 900 rpm，with a flow rate of between 3.5 and 4.5 L/min. The invasive mean arterial pressure was maintained between 65 and 75 mmHg，and blood lactate，cTnI，and cTnT levels returned to normal on the day of surgery and on the 7th day postoperatively. The endotracheal tube was removed 26 h after surgery，and episodes of short bursts of ventricular tachycardia and ventricular fibrillation occurred between the 7th and 15th days postoperatively.During this period，asynchronous defibrillation was repeatedly performed at 100 ～ 200 J，and the endotracheal tube wasreinserted on the 8th day after the surgery. The patient was smoothly discharged with the CH-VAD pump on the 90th day after the operation，with a pump speed of 2 800 rpm and a flow of 3.9 L/min. Twelve months after the surgery，the patient's ultrasound indicated an LVEDD of 60 mm，an LVEF of 29%，restoration of the aortic valve and cardiac cycle opening ratio to 1 ∶ 1，NYHA Class Ⅰ，and a 6-minute walk distance of 490 m. The dressing on the driveline cable woundwas changed once a day，with no abnormalities such as wound redness，effusion，or purulent secretions. The dressing onthe driveline cable wound was changed onceaday，withnoabnormalities such aswoundredness，effusion，orpurulent secretions. ConclusionLong-termimplantableVADis aneffectivetreatmentstrategy forpatients with acute myocardialinfarction combined with intractable cardiogenicshockand should beconsidered as earlyas possible. 

Key words:

"> Ventricularassist device, Acute myocardial infarction, Cardiogenic shock, Blood pump