補助循環用ポンプカテーテルで心機能改善を得た心原性ショックを伴う重症3枝病変の1例

Successful Use of Percutaneous Left Ventricular Assist Device （Impella） and Veno Artery Extracorporeal Membrane Oxygenation （VA-ECMO） for Ischemic Cardiogenic Shock；Report of a Case

はじめに　補助循環用ポンプカテーテル（Impella：Abiomed社，Danvers）は，内科的治療抵抗性の重症急性心不全に対して経皮的にポンプカテーテルを挿入し，左室内から血液を吸引して上行大動脈に送り出す装置である．それにより心筋への負荷を軽減しながら順行性の血流補助を行うことで，血行動態の改善，左室心筋の回復をめざす1，2）．われわれは虚血性急性心不全で経皮的人工心肺装置［veno artery extracorporeal membrane oxygenation （VA-ECMO），経皮的心肺補助装置（PCPS）］およびImpellaを併用し（いわゆるEcpella）3，4），循環動態の維持および左室機能の著明な改善を得た後，心拍動下冠状動脈バイパス術（OPCAB）を行った症例を経験したので報告する．

A 73-year-old male was referred to our hospital for acute congestive heart failure. His cardiac and respiratory conditions were worsening with cardiogenic shock requiring intubation. Coronary angiography revealed severe triple vessel disease, and echocardiography showed severe left ventricular dysfunction. Therefore, he underwent veno artery extracorporeal membrane oxygenation （VA-ECMO） followed by percutaneous left ventricular assist device （Impella）. His cardiac condition improved and VA-ECMO and Impella were removed on the 2nd day and the 4th day after surgery, respectively. He underwent off-pump coronary artery bypass grafting （OPCAB） without any complication on the 36th day. Postoperative course was uneventful and he was discharged on postoperative day 30. Concomitant use of Impella and VA-ECMO （Ecpella） remarkably improved ischemic cardiogenic shock by unloading the left ventricle and increasing the cardiac output.