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在格伦生理学中逐步进行心室辅助装置策略的改善结果:单中心体验
Eitan Keizman1, Emile A Bacha2, Kerry Schindler3
1Division of Cardiac Surgery, Department of Surgery, Columbia University, New York, New York; Pediatric and Congenital Cardiac Surgery Department, The Edmond J. Safra International Congenital Heart Center, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.
The Journal of thoracic and cardiovascular surgery
|February 14, 2026
概括
使用离心器和氧化器的分阶段机械循环支持策略,然后使用脉动器,改善了等待心脏移植的失败格伦循环患者的生存率.
科学领域:
- 心脏病学 心脏病学
- 儿科心脏手术 儿科心脏手术
- 机械循环支持 机械循环支持
背景情况:
- 在双向格伦阶段失败的单心房生理学对机械循环支持提出了重大挑战.
- 从历史上看,由于独特的循环动态,这些患者的心室辅助器件 (VAD) 结果很差.
- 最近的多中心数据表明,改善了这一群体的生存率.
研究的目的:
- 为了评估失败格伦循环的患者逐步VAD策略的结果.
- 评估初始离心流支的有效性,使用氧化器,然后过渡到持久的脉动支.
- 将生存率与历史数据进行比较.
主要方法:
- 在2018年至2025年期间,对9名连续接受VAD植入的Glenn患者进行了审查.
- 最初使用临时离心器装置,在以后的案例中常规添加氧化器.
- 在稳定的患者中,随后转换为持久的脉动支持 (柏林心脏EXCOR).
- 测量的主要结果是心脏移植后的存活率.
主要成果:
- 植入时的平均年龄为1.4岁;60%的患者已成功移植.
- 七名患者 (70%) 在初始离心器VAD使用后过渡到持久的脉动支持.
- 不良事件很常见 (每患者中位数为3),包括感染,出血和血液溶解.
- 两名患者在VAD支持下死亡;两名患者在支持下仍然活着.
结论:
- 一个分阶段的VAD策略,结合氧化器和随后的脉动支持的临时离心支持,改善了失败格伦循环的生存率.
- 尽管经常出现不良事件,但这种方法有效地将大多数高风险患者连接到移植.
- 对于这个具有挑战性的患者群体,需要在更大的多中心研究中进一步验证.
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