四例左心室辅助装置植入术患者的术后管理并文献复习
Postoperative Management of Four Patients Undergoing Left Heart Assist Device Implantation and Literature Review
DOI: 10.12677/acm.2026.1672564, PDF,    科研立项经费支持
作者: 王衍智：济宁医学院临床医学院(附属医院)，山东 济宁；费忠化*：济宁医学院附属医院心脏重症医学科，山东 济宁
关键词: 左心辅助装置植入术；术后并发症；术后管理；Left Ventricular Assist Device Implantation； Postoperative Complications； Postoperative Management
摘要: 2024年1月至2025年3月，济宁医学院附属医院心脏外科为4例终末期心力衰竭男性患者(年龄41~62岁)施行左心室辅助装置植入术。患者术前心功能均为NYHA IV级，INTERMACS分级2~3级。术后并发症包括容量过负荷1例、早期出血1例、心包压塞合并严重室性心律失常1例，经相应处理后所有患者均康复出院。院外予以华法林抗凝治疗，患者生活质量显著改善。本组病例表明，LVAD植入术可为终末期心衰患者提供有效治疗选择，但围术期并发症管理是影响预后的关键，需予以高度重视。
Abstract: From January 2024 to March 2025, four male patients (aged 41~62 years) with end-stage heart failure underwent left ventricular assist device implantation in the Cardiac Surgery Department of Jining Medical University Affiliated Hospital. All patients had preoperative cardiac function classified as NYHA class IV and INTERMACS profile II~III. Postoperative complications included volume overload in one case, early bleeding in one case, and cardiac tamponade combined with severe ventricular arrhythmia in one case. All patients recovered and were discharged after appropriate treatment. They were maintained on warfarin anticoagulation therapy after discharge, with significant improvement in quality of life. This case series demonstrates that LVAD implantation can be an effective therapeutic option for patients with end-stage heart failure. However, perioperative complication management is crucial for prognosis and requires high attention.
文章引用：王衍智, 费忠化. 四例左心室辅助装置植入术患者的术后管理并文献复习[J]. 临床医学进展, 2026, 16(7): 588-594. https://doi.org/10.12677/acm.2026.1672564

参考文献

[1] Varshney, A.S., DeFilippis, E.M., Cowger, J.A., Netuka, I., Pinney, S.P. and Givertz, M.M. (2022) Trends and Outcomes of Left Ventricular Assist Device Therapy: JACC Focus Seminar. Journal of the American College of Cardiology, 79, 1092-1107. [Google Scholar] [CrossRef] [PubMed]
[2] Wang, X., Zhou, X., Chen, H., Du, J., Qing, P., Zou, L., et al. (2024) Long-Term Outcomes of a Novel Fully Magnetically Levitated Ventricular Assist Device for the Treatment of Advanced Heart Failure in China. The Journal of Heart and Lung Transplantation, 43, 1806-1815. [Google Scholar] [CrossRef] [PubMed]
[3] Goswami, D., DiGiusto, M., Wadia, R., Barnes, S., Schwartz, J., Steppan, D., et al. (2020) The Use of Bivalirudin in Pediatric Cardiac Surgery and in the Interventional Cardiology Suite. Journal of Cardiothoracic and Vascular Anesthesia, 34, 2215-2223. [Google Scholar] [CrossRef] [PubMed]
[4] 中国生物医学工程学会机械循环支持分会, 中国心室辅助装置专家共识委员会, 胡盛寿, 等. 中国左心室辅助装置植入术后早期重症监护管理专家共识(2024年) [J]. 中国循环杂志, 2024, 39(8): 729-750.
[5] Iwasaki, K., Yoshitake, K., Yagi, N., Sujino, Y., Anegawa, E., Mochizuki, H., et al. (2020) Incidence, Factors, and Prognostic Impact of Re-Exploration for Bleeding after Continuous-Flow Left Ventricular Assist Device Implantation—A Japanese Single-Center Study. Circulation Journal, 84, 1949-1956. [Google Scholar] [CrossRef] [PubMed]
[6] 吴青松, 董疑, 陈良万. 左心室辅助装置植入患者的术后管理策略[J]. 中国心血管杂志, 2024, 29(1): 5-9.
[7] Briasoulis, A., Ueyama, H., Kuno, T., Asleh, R., Briasouli, A., Doulamis, I., et al. (2022) Analysis of Trends and Outcomes of 90 and 180 Day Readmissions after Left Ventricular Assist Device Implantation. ASAIO Journal, 68, 356-362. [Google Scholar] [CrossRef] [PubMed]
[8] Selmi, M., Chiu, W., Chivukula, V.K., Melisurgo, G., Beckman, J.A., Mahr, C., et al. (2019) Blood Damage in Left Ventricular Assist Devices: Pump Thrombosis or System Thrombosis? The International Journal of Artificial Organs, 42, 113-124. [Google Scholar] [CrossRef] [PubMed]
[9] Naqvi, S.Y., Jawaid, A., Dao, B., Falvey, J., Vidula, H., Gosev, I., et al. (2022) Management of Heparin-Induced Thrombocytopenia Using Plasmapharesis in Patients Undergoing Heartmate 3 Left Ventricular Assist Device. ASAIO Journal, 68, e152-e155. [Google Scholar] [CrossRef] [PubMed]
[10] Victor, S., Hayanga, J.W.A., Bozek, J.S., Wendel, J., Lagazzi, L.F. and Hayanga, H.K. (2022) Cardiac Tamponade Causing Predominant Left Atrial and Ventricular Compression after Left Ventricular Assist Device Placement. American Journal of Case Reports, 23, e938115. [Google Scholar] [CrossRef] [PubMed]
[11] Saeed, D., Feldman, D., Banayosy, A.E., Birks, E., Blume, E., Cowger, J., et al. (2023) The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10-Year Update. The Journal of Heart and Lung Transplantation, 42, e1-e222. [Google Scholar] [CrossRef] [PubMed]
[12] Chriqui, L., Monney, P., Kirsch, M. and Tozzi, P. (2021) Prediction of Right Ventricular Failure after Left Ventricular Assist Device Implantation in Patients with Heart Failure: A Meta-Analysis Comparing Echocardiographic Parameters. Interactive CardioVascular and Thoracic Surgery, 33, 784-792. [Google Scholar] [CrossRef] [PubMed]
[13] Pillai, A., Jedeon, Z., Hammond, J., Gluck, J. and Jaiswal, A. (2024) Intracardiac Shunt Reversal and Early Right Ventricular Failure after Left Ventricular Assist Device Implantation. Cureus, 16, e65320. [Google Scholar] [CrossRef] [PubMed]
[14] Karikalan, S., Tan, M.C., Zhang, N., El‐Masry, H., Killu, A.M., DeSimone, C.V., et al. (2024) Electrical Storm after Left Ventricular Assist Device (LVAD) Implantation. Journal of Cardiovascular Electrophysiology, 35, 1196-1202. [Google Scholar] [CrossRef] [PubMed]
[15] Shi, J., Yu, X. and Liu, Z. (2022) A Review of New-Onset Ventricular Arrhythmia after Left Ventricular Assist Device Implantation. Cardiology, 147, 315-327. [Google Scholar] [CrossRef] [PubMed]
[16] Ziv, O., Dizon, J., Thosani, A., Naka, Y., Magnano, A.R. and Garan, H. (2005) Effects of Left Ventricular Assist Device Therapy on Ventricular Arrhythmias. Journal of the American College of Cardiology, 45, 1428-1434. [Google Scholar] [CrossRef] [PubMed]
[17] Bohonos, C.J., Bechtum, E.L., Luckhardt, A.J., Clavell, A.L., Stulak, J.M. and Boilson, B.A. (2020) Ventricular Tachycardia and Preload Deficiency Post LVAD—The Importance of Integrated Assessment. Heart & Lung, 49, 481-487. [Google Scholar] [CrossRef] [PubMed]
[18] Oates, C.P., Lam, P.H., Lawrence, L., Bigham, G., Meda, N.S., Basyal, B., et al. (2024) Early Ventricular Arrhythmias after Left Ventricular Assist Device Implantation. Journal of Cardiac Failure, 30, 1018-1027. [Google Scholar] [CrossRef] [PubMed]
[19] Galand, V., Flécher, E., Auffret, V., Pichard, C., Boulé, S., Vincentelli, A., et al. (2019) Early Ventricular Arrhythmias after LVAD Implantation Is the Strongest Predictor of 30-Day Post-Operative Mortality. JACC: Clinical Electrophysiology, 5, 944-954. [Google Scholar] [CrossRef] [PubMed]

为你推荐