【体外膜肺ECMO精品课件】 Ventricular Assist Device.pptVIP

Ventricular Assist Device Seoul National University Hospital Department of Thoracic Cardiovascular Surgery Acute Heart Failure in Child Etiology Previous well child with structurally normal heart, most commonly, secondary to acute or fulminant myocarditis (lymphocytic myocarditis) or cardiomyopathy Childrens, either in the early postoperative, or longstanding myocardial dysfunction with congenital heart disease Acute Heart Failure in child Non-pharmachologic treatment Balance between myocardial oxygen demand and delivery Temperature control Mechanical circulatory support Intraaortic balloon pump Cardiopulmonary interaction; role of mechanical ventilation Mechanical Support Indications Acute myocarditis Low cardiac output state after cardiac surgery A bridge to transplantation Overwhelming systemic sepsis with circulatory failure Severe pulmonary hypertension Emergency management of intractable arrhythmia with severely compromised myocardial perfusion, subendocardial ischemia, and acute ventricular dysfunction Ventricular Assist Device Ideal requirements 1. Durable 2. Biocompatible 3. Nonthrombogenic 4. Resistant to infection 5. Reasonably priced 6. Available numerous size Ventricular Assist Device Recent available specification Centrifugal pump Implantable pneumatic pulsatile Heartmate(Thermo Cardiosystem) Paracorporeal ABIOMED BVS 5000 pump(ABIOMED) Paracorporeal pneumatic pulsatile Thoratec VAD(Thoratec Laboratories) Paracorporeal pulsatile pediatric VAD System including Berlin Heart VAD(Mediport Kardiotechnik) MEDOS HIA-VAD System(BYTEC GmbH) Jarvik 2000 System( Jarvik Research) Intraaortic Balloon Pump Calculation of IABP volume CO = HR x SV SV = CO / HR CI = CO / BSA CO = CI x BSA SV = ( CI x BSA ) / HR IABP volume = 0.5 x SV = 0.5 x (CI x BSA)/HR Assume CI = 2.0L/min/square M Then, IABP volume = ( 1000 x BSA ) / HR Mechanical Circulatory Support ECMO 1) ACT time 180-220 sec( around 200 ) 2) Antifibrinolytic therapy Initiation ; 100mg