ventricularassistdevices-cardiacanesthesiabasics心室辅助装置心脏麻醉的基础

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1、VentricularAssistDevicesBrianSchwartz,CCPFebruary25,2003CriteriaforVentricularAssistDevicesCardiacIndex<2.0L/m2/minSVR>2,100dyn/sec/cm2SystolicPressure<80mmHgAtrialPressure>20mmHgAssisted(diuretics)UrineOutput<20ml/hrMetabolicAcidosisCriteriaforVentricul

2、arAssistDevicesFailuretoseparatefromCPBIrreversiblecardiacinjuryShortTermSupportCardiopulmonarybypassResuscitation15%survivalrateImmediatelyabletosupportpatientNeedtofullyheparinizepatientCPRProvidessupporttemporarilyDevicesUsedtoAssisttheVentricle(Mode

3、rateSetting)Intra-aorticballoonpumpCardiopulmonarySupport(CPS)CentrifugalPump“Bio-Head”Abiomed(BVS-5000)Bi-VadIntra-aorticBalloonPumpsTheleastcomplicatedmeansofcirculatoryassistanceEffectsofIABPAugmentationofDiastolicPressureDecreaseAfterloadDecreasemyoc

4、ardialoxygenconsumptionAugmentsC.O.by10%(500-800cc/min)RelativelyinexpensiveIntra-aorticBalloonPumps(Indications)CardiogenicshockfollowingMIUnstableAnginaLeftMainDiseaseVentricularDysrhythmiasSepticShockIntra-aorticBalloonPumps(Contraindications)AIAort

5、icAneurysmSevereFemoralDiseaseCardiopulmonarySupport(CPS)PercutaneousinsertionNeedoxygenatorandheatexchangerCannulatebothfemoralarteryandfemoralveinNeedscontinuousmonitoring,thereforeverylaborintensiveMaximumsupport…48hoursCentrifugalPumpEasytoprimeandse

6、tupRequirescontinuousmonitoringKineticassistedvenousdrainageACT’saround180-200secondsModeratecostAbiomedQuickset-upMinimalbedsidemonitoringSupportslargechildrenandadultsFlowratesupto5L/MinMaximumuse….1weekPatientsarenotmobileHighcostLongTermDevicesforVen

7、tricularSupportTCI(HeartmateIP1000)PneumaticLVADonlyTCI(VE)VentedElectricLVADonlyNovacor(N100P)ElectricLVADonlyThoratecPneumaticLVAD,RVAD,Bi-VADHeartmatePneumaticLVADAllowsbloodflowstoexceed10litersperminuteInsertedduringCPBMinimumBSArequired…1.7Verycost

8、lytoinsertHeartmateVentedElectricLVADAllowsflowsexceeding10litersNeedCPBforplacementBSArequirement…greaterthan1.7PatientsareabletogohomeMinimalanti-coagulationHighcostTotalArtificialHeartCardioWest(C-70)Pneumatictotalartif