血液动力学支持与Impella 5.5急性机械循环支持装置
James W Schurr1, Adrian Pearson1, Matthew S Delfiner1
1From the Cardiovascular Division, Department of Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania.
概括
伊佩拉5.5有效地将患者连接到康复或心脏移植,显示出改善的血液动力学和降低的肺压力. 对于患有并存右心室功能障碍的患者,仔细监测是关键.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 血液动力学 血液动力学
背景情况:
- 伊佩拉5.5越来越多地用于高级心力衰竭管理.
- 临床试验证据证明其有效性有限,需要真实世界的结果数据.
研究的目的:
- 评估Impella 5.5在需要循环支持的患者中的实际结果和血液动力学影响.
- 评估Impella 5.5作为通往康复,耐用左心室辅助装置 (LVAD) 或心脏移植的桥梁的作用.
主要方法:
- 一项对150名连续接受Impella 5.5支持的患者的回顾性分析.
- 主要结局:复合的恢复,持久的LVAD或心脏移植与90天死亡率.
- 二次结果:血液动力学趋势和升级到静脉动脉外体膜氧化 (VA-ECMO) 的需要.
主要成果:
- 综合终点 (恢复,LVAD或移植) 在59.3%的患者中发生,90天死亡率为18.8%.
- 支持Impella 5.5导致肺动脉透析压 (PADP),估计的肺动脉弹性 (Ea) 和血管活性-无热积分 (VIS) 的显著降低.
- 需要VA-ECMO升级的患者表现出更高的基线右心房压力 (RAP),PADP和下肺动脉脉动指数 (PAPi),表明潜在的右心室功能障碍.
结论:
- 伊佩拉5.5在改善血液动力学和将患者连接到康复或心脏替代疗法方面表现出有效性.
- 血液动力学监测对于管理Impella 5.5患者至关重要,特别是那些同时出现右心室功能障碍的患者.
- 现实世界的数据支持Impella 5.5在管理晚期心力衰竭方面的作用.
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