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1、会计学1VentricularAssistDevicescardiacanesthesiabasics心室辅助装置心室辅助装置(zhungzh)心脏麻醉的基础心脏麻醉的基础第一页，共24页。Criteria for Ventricular Assist Devicesn nCardiac Index 2,100 dyn/sec/cm2n nSystolic Pressure 20 mmHgn nAssisted (diuretics) Urine Output 1.7 n nNeed CPB for implantn nNative heart not excisedn nNeed Anti-
2、coagulation n nPatient in-house but mobile第14页/共23页第十五页，共24页。Total Artificial Heartn nAbiomeds total artificial heartn nStill in clinical trialsn nFirst patient lasted several months on devicen nIf successful, will save hundreds of thousands of live because there will be no waiting like the transpla
3、nt list第15页/共23页第十六页，共24页。Signs indicating Left Ventricular Failuren nDecreased contractility n nElevated left ventricular filling pressuresn nElevated pulmonary capillary wedge pressuresn nDecrease pulmonary oxygenation 第16页/共23页第十七页，共24页。Signs of Right Ventricular Failuren nCardiac Index less than
4、 1.8 L/min/m2n nAortic pressure less than 90 mmHgn nAtrial pressure greater than 20 mmHgn nPulmonary capillary wedge pressure less than 10 mmHg第17页/共23页第十八页，共24页。Cannulation sites for LVADsn nInletn nLeft atrium n nLeft ventricle n nLeft superior pulmonary veinn nOutletn nAorta第18页/共23页第十九页，共24页。Can
5、nulation sites for RVADsn nInletn nRight atriumn nOutletn nPulmonary artery第19页/共23页第二十页，共24页。Heparin Management in Patients with VADsn nACTs are maintained around 180-200 secondsas long as the cardiac output is above three liters per minuten nACTs are maintained above 300 seconds while the cardiac
6、output is below three liters per minuten nWHEN IS THIS IMPORTANT?第20页/共23页第二十一页，共24页。Discontinuing a VADn nIf possible, the heart is allowed to rest for 48-72 hoursIf possible, the heart is allowed to rest for 48-72 hoursn nWeaning the patient off the assist devices is then performed. ( Weaning the
7、patient off the assist devices is then performed. ( Patient needs to have a native C.I. of at least 2.2 L/min/m2)Patient needs to have a native C.I. of at least 2.2 L/min/m2)n nACTs are increased to compensate for the low flowsACTs are increased to compensate for the low flowsn nIf the patient toler
8、ates the low flows, he/she is separated from the assist If the patient tolerates the low flows, he/she is separated from the assist devices and the cannulae are removeddevices and the cannulae are removed第21页/共23页第二十二页，共24页。VAD Protocol for Your Institution n nKnow your protocoln nKnow your equipmen
9、tn nBe able to predict those patients at riskn nBe able to prime in an orderly fashionn nBe prepared to assist the surgeons n nHelp educate all staff working with the patient第22页/共23页第二十三页，共24页。内容(nirng)总结会计学。Centrifugal Pump “Bio-Head”。Abiomed (BVS-5000) Bi-Vad。Intra-aortic Balloon Pumps。Intra-aortic Balloon Pumps(Contraindications)。LVAD, RVAD, Bi-VAD。Pulmonary artery。第22页/共23页第二十四页，共24页。
