Aeson全人工心脏用于急性心肌梗死后室间隔缺损患者的初步经验
Initial Experience With the Aeson Total Artificial Heart in Patients With Ventricular Septal Defect After Acute Myocardial Infarction
急性心肌梗死后室间隔缺损（心脏左右心室之间的隔膜破口）极为凶险，当缺损广泛、无法手术修补时几乎无解。本研究在德国和法国四个中心回顾性分析了10例重度心源性休克患者，均为男性，接受Aeson全人工心脏（完全替代自身心脏的机械泵）植入，此前4例手术修补失败、6例因缺损累及瓣膜结构不适合手术。植入后多数患者早期拔管，8例（80%）在中位167天支持后成功过渡到心脏移植，6个月生存率80%、1年60%。这提示全人工心脏可作为此类原本致命情况下的“桥接移植”策略，但样本小、为回顾性设计。
为什么推荐给您：全人工心脏首次用于无法修复的梗死后室间隔缺损，属新适应证的早期人体经验。
不需要生物学背景，多打比方
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摘要Abstract
BACKGROUND: Post-myocardial infarction ventricular septal defect (VSD) is a rare but highly lethal complication of acute myocardial infarction. In cases of extensive septal destruction, surgical reconstruction is often not feasible. We report the first clinical experience with implantation of the Aeson total artificial heart (TAH) in patients with irreparable post-infarction VSD.
METHODS: This multicenter retrospective analysis included 10 male patients with severe cardiogenic shock who underwent Aeson TAH implantation at four centers in Germany and France between November 2022 and March 2025. All patients required temporary mechanical circulatory support before implantation. Previous surgical VSD repair had failed in four patients, while six were considered unsuitable for surgical reconstruction because of extensive basal septal defects involving the atrioventricular valve apparatus.
RESULTS: Following TAH implantation, early extubation was achieved in most patients, whereas three required temporary veno-venous extracorporeal membrane oxygenation support. No cases of permanent renal failure, irreversible hepatic dysfunction, or neurological complications such as stroke were observed. Eight patients (80%) were successfully bridged to heart transplantation after a median support duration of 167 days, while one patient remains on ongoing device support. During a median follow-up of 351 days (interquartile range, 202-470 days), four patients died. Overall survival was 80% at 6 months and 60% at 1 year after implantation.
CONCLUSIONS: Aeson TAH implantation appears to be a feasible bridge-to-transplant strategy for selected patients with irreparable post-myocardial infarction VSD. The procedure provided hemodynamic stabilization, facilitated recovery of end-organ function, and resulted in favorable short- to mid-term outcomes in an otherwise fatal clinical condition.