69
Transfemoral Placement of the Left Ventricular Assist Device "Hemopump" During Mechanical Resuscitation K. H. Scholz', U. Tebbe' , M. Chemnitius', H. Kreuzer' ; T. Schroder. J. P. Herinq', l~ Uhlir! . G. llelliqe", H. 1. Grime', R. Autschbach", B. Schorn' , W Ruschetoski' , an d H. Dalichau' 1 Dep a rt ment of Ca rd iology a nd Pulmonology a Dep artmen t of Expe rime ntal Ca rd iology 3 Dep artmen t of Pat hology ~ Dep a rt men t of Thoracic a nd Card iovas cu lar Surgery University of Gdutngen . G6tti ngen . FRG
The Hemo pump is a new left-ve ntricular assist device (21 F diam eter) , which pro vides up to 3.5 U rnin output aft er pla cement in th e left vent ricle via the fem or al arte ry. We desc ribe th e first ca se in wh ich th e device was inserte d
during resuscitation. The patient developed untre atable susta ined ven tri cular tac hycardias/fibrillation 40 hours afte r corona ry a rtery bypass graft ing. After prolonge d mechan ical resu scitatio n (ab out 3 hours) as a last resor t the Hem opump wa s inserted an d rh yth m a nd hemodyna mics sta bilized. In the following hour s a decr ea se in ao rtic pre ssur e pulsatil ity ind icated , effective left vent ricu lar sup por t when the Hernopurnp was ru nni ng. For short peri ods the pa tien t had non pulsa tile aor tic pr essure wave form s, imp lying comp lete pump depen dence . In this situation ca rdiac out put was abo ut 3.0 lJmin, mean ao rtic pressure rea ched nearl y 50 mmllg using high dos age of catecholamines . Th e pati en t remained pump -depen dent a nd d ied du e to untreata ble ventricular fibrillation. There was no sig nificant hemolysis during th e 20 hours the lIem opump was running. Autopsy revealed no signs of'th ro mbembolism, bu t int imal lesions of the A. iliaca a nd of the abdo minal aorta with subse que nt th rombus format ion we re demonstra ted . In view of the expe rime nta lly pr oven ben efit in card ioge nic shock a nd pr oblem s a nd risks ca used by the insertion , future indication s for clinical use of this new device a re discussed . Keywords Cardiogen ic shock - Resu scitat ion - Mech ani ca l circ ulato ry su pport - Left ventricular assist device
Introdu ction Poor hemod ynam ics in ca rdiogenic shock result from both reduced left ventricular output and elevated left ventricular filling pr essure. Impaired myocardial pumping function in cardiogenic shock redu ces coronary perfu sion, and, in a vicious cycle, furth er augm ents deteri orati on of cardiac energy balance. Left ventricular assist systems are exceedin gly elaborate with regard to both implantation and hand ling. and Thorae. eardiovase. Surgn 38 (1990) 69-72 © Georg Thieme Verlag Stuttgart - New York
Mit de m kurz bch en twic kelten linksventrikularen AssistSystem .H emo pump ". einer tran sfem oral im linkc n Vent rikel plazierba ren rotierend en Pum pe nach dem Arch imedesSchrauben pr inz ip (Dur chm esser : 21 Fre nc h]. ist in vitro cine Porde rlelstung bis zu 3,5 lJmin mogltch . Auf der Ba sis um fan gr eicher tier exp eri ment eller Untersuch unge n hab en wir das Verfa hrc n als ultima ratio bei einem S'lja hrige n Pat ienten ei ngesetzt, bei de m 40 Stunde n na ch einc r Coro na rbypa sso peration nicht beh errschba re ven tri kula re Hhythmu sst c run gen aufgetreten wa re n. Es gelang erstrna ls eine Impla ntation wa hre nd mcch anischer Reani ma tion . unrn ittelba r nach Plaz ierung ka m es zunachst zu ci ncr Stabilisierung von Rhythrnus un d Hdmodynaml k. Der Pumpb etrieb fuh rte zu einer Vcrringerung der Aorte nd ruc ka rnplitude {mit Anst ieg des diastolischen und Red uktion des systolis che n Druckesl als Ausd ru ck eine r de utlichen lin ksven trikul a ren Entlas tu ng. Phasenweisc ka m es zu ei ner vollsta ndige n Oberna hme der Pumpf un ktion Inlcht-pu lsa tller Aortend ruckl . da bei wurde bei ci ne m Her zzeitvolurnen von 3,0 11 min ein mi ttler er Aortend ruck von ca . 50 mm Hg erreicht . Der Patient kon nte jcdoch nicht von der Pumpe entwohnt werden und starb a n Pum pversagcn und nicht beh errsch baren HhythmusstOrungen . Wa h rend des 20 stGnd igen Bet rieb s ist es zu keiner relevan ten Hamolyse gekomme n. Die Auto ps ie crgab bei ausgepragten at hercskler otlsch en vera nderunge n Intim averl etzu ngen im Bereich der A. ilia ca und der Aorta abdo mi na lis, fiir thro mboembolische Ereign isse ergab sich kern An halt. Mogliche zukiinftige Ind ikat ionen fur den Eins atz des vc rfahrc ns werden d iskut iert.
thu s a re not routinely used (2. 5). Up to now. only intraao rtic ballon counterpulsation (IABP) has gained major clinical relevan ce for the tr eatm ent of pati ents with cardiogenic shock (2. 3). With this system. left vent ricula r afterload is redu ced and corona ry per fusion is increased by diastolic pr essure augme ntation. However , with this techniqu e clinical improveme nt depends on residual left ventricular pump function . The Hemopump is a new left ventricular assist device which ha s been developed and recently described in deta il Received for Publication: February 9. 1990
Downloaded by: Universite Laval. Copyrighted material.
Summary
Pla zierung des lransfemoral impla nlie r ba re n lin ksventrikuHi rc n Assist-Systems ..l lemopump" wa hren d mechanischer Re animalion
Thome. cardiovasc. Surgn 38 (J 990)
K. H. Scholz et al.
axial flow pump
cannula
Case Repor t
Transfemoral Placement of the Left Ventricular Assist Device "Hemopump" During Mechanical Resuscitation K. H. Scholz', U. Tebbe' , M. Chemnitius', H. Kreuzer' ; T. Schroder. J. P. Herinq', l~ Uhlir! . G. llelliqe", H. 1. Grime', R. Autschbach", B. Schorn' , W Ruschetoski' , an d H. Dalichau' 1 Dep a rt ment of Ca rd iology a nd Pulmonology a Dep artmen t of Expe rime ntal Ca rd iology 3 Dep artmen t of Pat hology ~ Dep a rt men t of Thoracic a nd Card iovas cu lar Surgery University of Gdutngen . G6tti ngen . FRG
The Hemo pump is a new left-ve ntricular assist device (21 F diam eter) , which pro vides up to 3.5 U rnin output aft er pla cement in th e left vent ricle via the fem or al arte ry. We desc ribe th e first ca se in wh ich th e device was inserte d
during resuscitation. The patient developed untre atable susta ined ven tri cular tac hycardias/fibrillation 40 hours afte r corona ry a rtery bypass graft ing. After prolonge d mechan ical resu scitatio n (ab out 3 hours) as a last resor t the Hem opump wa s inserted an d rh yth m a nd hemodyna mics sta bilized. In the following hour s a decr ea se in ao rtic pre ssur e pulsatil ity ind icated , effective left vent ricu lar sup por t when the Hernopurnp was ru nni ng. For short peri ods the pa tien t had non pulsa tile aor tic pr essure wave form s, imp lying comp lete pump depen dence . In this situation ca rdiac out put was abo ut 3.0 lJmin, mean ao rtic pressure rea ched nearl y 50 mmllg using high dos age of catecholamines . Th e pati en t remained pump -depen dent a nd d ied du e to untreata ble ventricular fibrillation. There was no sig nificant hemolysis during th e 20 hours the lIem opump was running. Autopsy revealed no signs of'th ro mbembolism, bu t int imal lesions of the A. iliaca a nd of the abdo minal aorta with subse que nt th rombus format ion we re demonstra ted . In view of the expe rime nta lly pr oven ben efit in card ioge nic shock a nd pr oblem s a nd risks ca used by the insertion , future indication s for clinical use of this new device a re discussed . Keywords Cardiogen ic shock - Resu scitat ion - Mech ani ca l circ ulato ry su pport - Left ventricular assist device
Introdu ction Poor hemod ynam ics in ca rdiogenic shock result from both reduced left ventricular output and elevated left ventricular filling pr essure. Impaired myocardial pumping function in cardiogenic shock redu ces coronary perfu sion, and, in a vicious cycle, furth er augm ents deteri orati on of cardiac energy balance. Left ventricular assist systems are exceedin gly elaborate with regard to both implantation and hand ling. and Thorae. eardiovase. Surgn 38 (1990) 69-72 © Georg Thieme Verlag Stuttgart - New York
Mit de m kurz bch en twic kelten linksventrikularen AssistSystem .H emo pump ". einer tran sfem oral im linkc n Vent rikel plazierba ren rotierend en Pum pe nach dem Arch imedesSchrauben pr inz ip (Dur chm esser : 21 Fre nc h]. ist in vitro cine Porde rlelstung bis zu 3,5 lJmin mogltch . Auf der Ba sis um fan gr eicher tier exp eri ment eller Untersuch unge n hab en wir das Verfa hrc n als ultima ratio bei einem S'lja hrige n Pat ienten ei ngesetzt, bei de m 40 Stunde n na ch einc r Coro na rbypa sso peration nicht beh errschba re ven tri kula re Hhythmu sst c run gen aufgetreten wa re n. Es gelang erstrna ls eine Impla ntation wa hre nd mcch anischer Reani ma tion . unrn ittelba r nach Plaz ierung ka m es zunachst zu ci ncr Stabilisierung von Rhythrnus un d Hdmodynaml k. Der Pumpb etrieb fuh rte zu einer Vcrringerung der Aorte nd ruc ka rnplitude {mit Anst ieg des diastolischen und Red uktion des systolis che n Druckesl als Ausd ru ck eine r de utlichen lin ksven trikul a ren Entlas tu ng. Phasenweisc ka m es zu ei ner vollsta ndige n Oberna hme der Pumpf un ktion Inlcht-pu lsa tller Aortend ruckl . da bei wurde bei ci ne m Her zzeitvolurnen von 3,0 11 min ein mi ttler er Aortend ruck von ca . 50 mm Hg erreicht . Der Patient kon nte jcdoch nicht von der Pumpe entwohnt werden und starb a n Pum pversagcn und nicht beh errsch baren HhythmusstOrungen . Wa h rend des 20 stGnd igen Bet rieb s ist es zu keiner relevan ten Hamolyse gekomme n. Die Auto ps ie crgab bei ausgepragten at hercskler otlsch en vera nderunge n Intim averl etzu ngen im Bereich der A. ilia ca und der Aorta abdo mi na lis, fiir thro mboembolische Ereign isse ergab sich kern An halt. Mogliche zukiinftige Ind ikat ionen fur den Eins atz des vc rfahrc ns werden d iskut iert.
thu s a re not routinely used (2. 5). Up to now. only intraao rtic ballon counterpulsation (IABP) has gained major clinical relevan ce for the tr eatm ent of pati ents with cardiogenic shock (2. 3). With this system. left vent ricula r afterload is redu ced and corona ry per fusion is increased by diastolic pr essure augme ntation. However , with this techniqu e clinical improveme nt depends on residual left ventricular pump function . The Hemopump is a new left ventricular assist device which ha s been developed and recently described in deta il Received for Publication: February 9. 1990
Downloaded by: Universite Laval. Copyrighted material.
Summary
Pla zierung des lransfemoral impla nlie r ba re n lin ksventrikuHi rc n Assist-Systems ..l lemopump" wa hren d mechanischer Re animalion
Thome. cardiovasc. Surgn 38 (J 990)
K. H. Scholz et al.
axial flow pump
cannula
Case Repor t
