補助循環用ポンプカテーテルを使用し救命しえた心原性ショックを伴う重症虚血性心不全の1例

Successful Use of Left Ventricular Support Device （Impella 5.0） for Ischemic Heart Disease with Cardiogenic Shock：Report of a Case

はじめに　Impella 5.0（Abiomed社，Danvers）は腋窩動脈からも挿入することのできる補助循環用ポンプカテーテルであり，呼吸不全を伴う患者のリハビリテーションにおいて有用である．われわれは，Impella 5.0による左室補助を行うことで救命しえた重症虚血性心不全の1例を経験したため報告する．

Postoperative hemodynamic support with an Impella 5.0 was effective in an obese man who underwent coronary artery bypass grafting （CABG） for ischemic heart disease and cardiogenic shock. A 43-year-old obese man presented to our hospital complaining severe chest pain. Coronary angiography revealed acute coronary syndrome due to severe triple-vessel disease, and the patient fell into a state of shock, which required veno-arterial extracorporeal membrane oxygenation （VA-ECMO） support. The patient subsequently underwent CABG, but he was unable to be separated from VA-ECMO. Impella 5.0 was introduced through right axillary artery on the next day. VA-ECMO was converted to veno-venous （VV）-ECMO on the 3rd postoperative day to enable respiratory rehabilitation in a sitting position；his respiratory status gradually improved. VV-ECMO and the Impella 5.0 were discontinued on the 6th and 7th postoperative days, respectively. He was eventually transferred to nearby facility for further rehabilitation three months later. As of two years, his cardiac function has improved and he is doing well at home.