VentricularAssistDevices-cardiacanesthesiabasics心室辅助装置心脏麻醉的基础.pptVIP

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VentricularAssistDevices-cardiacanesthesiabasics心室辅助装置心脏麻醉的基础.ppt

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

Ventricular Assist Devices Brian Schwartz, CCP February 25, 2003 Criteria for Ventricular Assist Devices Cardiac Index 2.0 L/m2/min SVR 2,100 dyn/sec/cm2 Systolic Pressure 80 mmHg Atrial Pressure 20 mmHg Assisted (diuretics) Urine Output 20 ml/hr Metabolic Acidosis Criteria for Ventricular Assist Devices Failure to separate from CPB Irreversible cardiac injury Short Term Support Cardiopulmonary bypass Resuscitation 15 % survival rate Immediately able to support patient Need to fully heparinize patient CPR Provides support temporarily Devices Used to Assist the Ventricle(Moderate Setting) Intra-aortic balloon pump Cardiopulmonary Support (CPS) Centrifugal Pump “Bio-Head” Abiomed (BVS-5000) Bi-Vad Intra-aortic Balloon Pumps The least complicated means of circulatory assistance Effects of IABP Augmentation of Diastolic Pressure Decrease Afterload Decrease myocardial oxygen consumption Augments C.O. by 10% (500-800 cc/min) Relatively inexpensive Intra-aortic Balloon Pumps(Indications) Cardiogenic shock following MI Unstable Angina Left Main Disease Ventricular Dysrhythmias Septic Shock Intra-aortic Balloon Pumps(Contraindications) AI Aortic Aneurysm Severe Femoral Disease Cardiopulmonary Support (CPS) Percutaneous insertion Need oxygenator and heat exchanger Cannulate both femoral artery and femoral vein Needs continuous monitoring, therefore very labor intensive Maximum support…48 hours Centrifugal Pump Easy to prime and set up Requires continuous monitoring Kinetic assisted venous drainage ACT’s around 180-200 seconds Moderate cost Abiomed Quick set-up Minimal bedside monitoring Supports large children and adults Flow rates up to 5 L/Min Maximum use….1 week Patients are not mobile High cost Long Term Devices for Ventricular Support TCI ( Heartmate IP 1000) Pneumatic LVAD only TCI (VE) Vented Electric LVAD only Novacor (N 100P) Electric LVAD only Thoratec Pneumatic LVAD, RVAD, Bi-VAD Heartmate Pneumatic LVAD Allows blood flows