Pregledni rad
Initial Clinical Results with the Levitronix Centrimag Mechanical Assist Device at the University Hospital Rebro Zagreb
Hrvoje Gašparović
; Departments of Cardiac Surgery, Anesthesiology and Cardiology, University Hospital Zagreb, Zagreb, Croatia
Mate Petričević
; Departments of Cardiac Surgery, Anesthesiology and Cardiology, University Hospital Zagreb, Zagreb, Croatia
Višnja Ivančan
; Departments of Cardiac Surgery, Anesthesiology and Cardiology, University Hospital Zagreb, Zagreb, Croatia
Davor Miličić
; Departments of Cardiac Surgery, Anesthesiology and Cardiology, University Hospital Zagreb, Zagreb, Croatia
Bojan Biočina
; Departments of Cardiac Surgery, Anesthesiology and Cardiology, University Hospital Zagreb, Zagreb, Croatia
Sažetak
Background: The management of end stage heart failure has been revolutionized by the use of mechanical circulatory support. The Levitronix Centrimag ventricular assist device (VAD) is designed for short-term cardiac assistance as a bridge to a more permanent solution to the hemodynamic problem. It has been used as bridge-to-transplantation, bridge-to-bridge, bridge-to-recovery, and bridge-to-decision. Methods: In the period between September 2008 and November 2009, six patients received mechanical cardiac assistance with the Levitronix Centrimag device at our institution. In one patient, the indication was postcardiotomy cardiogenic shock. In the remaining five patients, the device was implanted electively, due to progressive decompensation of chronic heart failure unresponsive to medical therapy. Results: The patient having received a biventricular assist device (BIVAD) in the postcardiotomy setting was 65 years of age. His ejection fraction and EuroSCORE were 20 % and 25, respectively. His NT-pro-BNP was 9,428 pg/ml and his pre-implantation lactate was 8.8 mmol/L. The mean age in the group of patients, in whom the VAD was placed due to decompensated severe heart failure (DSHF ), was 46 ± 11 years. Their ejection fraction and logistic EuroSCORE were 16 ± 2 % and 28 ± 7, respectively. The preoperative serum lactate and NT-pro-BNP concentrations were 1.7±0.8 mmol/L and 9577 ± 3674 pg/ml, respectively. Of these, three patients had evidence of end organ dysfunction. The low cardiac output was responsible for acute renal failure, requiring renal replacement therapy in one patient. Neurocognitive dysfunction and renal failure not requiring dialysis was seen in another. The third patient had long standing primary hepatic insufficiency. A reversal of end organ dysfunction was seen in the former two patients, whereas the hepatic insufficiency was not caused by hemodynamic compromise and was, therefore, not relieved by circulatory support. The single patient, who had suffered from postcardiotomy cardiogenic shock, died shortly after receiving mechanical circulatory support. Three of five patients, in whom Levitronix Centrimag was placed electively, were successfully transplanted. The remaining two died of septic complications. In the cohort of patients, in whom ventricular assistance was placed due to DSHF , two required BIVAD placement, and three left ventricular assist devices (LVAD). Conclusion: The Levitronix Centrimag VAD is useful in supporting circulation in patients with acute decompensation of congestive heart failure. It may also be used in patients with postcardiotomy shock. It is an imperative for the device to be placed before irreversible organ dysfunction occurs as the aftermath of malperfusion.
Ključne riječi
Levitronix Centrimag; ventricular assist device
Hrčak ID:
66342
URI
Datum izdavanja:
11.3.2011.
Posjeta: 1.590 *