[Heart assist (Vilnius University experience)].
Over the last three decades, the results of heart surgery have significantly improved. However, the number of patients at the last stages of heart deficiency has increased. Prevention provided to the patients suffering from heart diseases has improved the quality of their life and increased their lifetime. In spite of that, most of these patients sooner or later need a surgical treatment: heart surgery operation or heart transplantation. The visible damage to haemodynamics of the patients waiting for heart operations and particularly heart transplantations or after them has drawn the focus of heart surgeons to the mechanical systems of heart assist. In many cases they help to cure patients after post-cardiotomic or post-transplant cardiogenic progressive circulation and poly-organic deficiency. They also are regarded effective as a bridge to heart transplantation. In the Heart Surgery Center of Vilnius University, heart assist has been applied since 1976. Contrapulsation with intraaortic balloon pump has been applied to 856 patients, which after heart operations have developed progressive heart deficiency. Four methods of balloon insertion into aorta were used: through the a. iliaca incision (337 cases); through the a. femoralis punction (287 cases); through the ascending aorta (171 cases) and through the ascending aorta using tourniquets (61 cases). The best results were achieved employing intraaortic balloon pump after aorta-coronary bypass surgery: 67% patients were discharged from hospital. The worst results follow heart transplants, as intraaortic balloon pump was successful only to 28% of patients. In general, the total number of patients to whom the heart assist method was successful is 454 (53%). The second heart assist method that has been applied in our centre is the use of extracorporeal membranous oxigenator. It has been employed since 1998 to the patients with the critical respiration and heart deficiency. Extracorporeal membranous oxigenator has been used to 8 patients, to whom pharmaceutical treatment and intraaortic balloon pump were inefficient. Unfortunately, only one of the patients after 105 days was successfully disconnected from the extracorporeal membranous oxigenator, while maintaining his good haemodynamics. The third method of heart assist is the employment of artificial Berlin Heart ventricles. From 1999 up to 2003, 15 artificial Berlin Heart ventricles have been connected to thirteen patients, 7 of them as a bridge to heart transplant. One of the patients has already lived for over 2 years, while 6 patients had heart transplantation. There have been 8 post-cardiotomic patients with incorporated artificial Berlin Heart ventricles. The most experience has been accumulated in the use of intraaortic balloon pump. The fact that 53% of patients were discharged from hospital after such treatment indicates its efficiency. We have little experience in the employment of extracorporeal membranous oxigenator, therefore it is difficult to make conclusions. Whereas the application of Berlin Heart artificial ventricles is an effective method of assist circulation (heart assist), being a bridge to heart transplantation and effective in a long-term treatment.
Miniauskas
Saulius
S
Heart Surgery Center, Vilnius University, Santariskiu 2, 2021 Vilnius, Lithuania. cardiosurgery@omni.lt
Rucinskas
Kestutis
K
Rasimavicius
Gintaras
G
Sirvydis
Vytautas
V
D006348:Cardiac Surgical Procedures; D015908:Counterpulsation / Q000009:adverse effects; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D008097:Lithuania; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D010107:Oxygenators, Membrane; D011182:Postoperative Care; D011183:Postoperative Complications; D013997:Time Factors; D016896:Treatment Outcome