?????????? ?????? ????OT?S?OS ??? ???????? ???S?????? ???????O? ?????O?

1
?????????? ?????? ????OT?S?OS ??? ????????
???S?????? ???????O? ?????O?
2
???????? ??????????

• ?????
• ??????

3
?S??????

• 1953 JOHN GIBBON ?a?d??a?ap?e?st??? µ??a?? ??a
  d?????s? µes????p???? ep????????a?
• 1961 COOLEY ?a?d??a?ap?e?st??? s?s?e?? ??a
  a?t?µet?p?s? µa????? p?e?µ?????? eµß????
• 1962 DENNIS ?fa?µ??? a??ste??? ?a?d?a???
  pa???aµ??? ??a as?e?e?? p?? de? µp????sa?
  d?e??e????t??? ?a ap?desµe?t??? ap? t??
  e??s?µat??? ?????f???a
• 1962 MOULOPOULOS ?????? efa?µ??? t?? ?d?a? t??
  e?da??t???? a?t??a? a?t????se??
• 1968 KANTROWITZ ??????? efa?µ??? t?? e?da??t????
  a?t??a?

4
(No Transcript)
5
(No Transcript)
6
S?S????S ????????S ??????T?S?S

• S?S????S ???SO????S ??????T?S?S
• S?S????S ????????T?S??S ? ??????S ??????T?S?S

7
?????????? ?????? ????OT?S?OS
8
F?S????G?? ??S IABPC

• ?e??s? t?? s?st?????? a??t???? p?es?? ?a? ??a t??
  µetaf??t??? t?? a??ste??? ?????a?
• ????s? t?? d?ast?????? p?es?? t?? a??t?? ?a? ??a
  t?? p?es?? ??de?s?? t?? stefa??a??? a??e???
• ??????? ???O? ?????

9

• ????s? t?? ?a?d?a??? pa?????
• ????s? t?? stefa??a?a? a?µat???? ???
• ?e??s? t?? te??d?ast?????? ?a? te??s?st??????
  p?es?? t?? a??ste??? ?????a? ?a? ep?µ???? t??
  µ???a?d?a??? ?ata????s?? ????????

10
???????? ????G????S ??? ??????????? ??? ?????S?
??S IABP

• T?S? ??? ?S??? S??? ?????
• ??G?T?S ??? ?S???
• S?G????S??S ??S ???????S ??? ?S??? ?? ??
  S?G????S? ??S ???????S ???????S

11
?????G???? ????G????S ??? ??????????? ??? ?????S?
??S IABP

• ????????S ??T??S
• ???????? S????????
• ???S?????? ??????? ???S?
• ???????? ???????S ???????S
• ???????????? ???????? ????O????S

12
????????S ????T???S?S ??????????S ??????S (1)

• ??????G???S ?????????? (?et? pe???a?d??t?µ?, µet?
  ap? ??? ?µf?a?µa t?? µ???a?d???, se ??e?a
  µ???a?d?t?da ?? ??f??a ??a ?as? ,µetaµ?s?e?s? ?
  ??a t?p???t?s? ??p??a? p?? µ???µ?? s?s?e???
  ?a?d?a??? ?p?ß????s??, se µ??a????? ep?p?????
  ????? eµf???µat?? µ???a?d???)

13
????????S ????T???S?S ??????????S ??????S(2)

• S? ??????S??S ?????S??F??????S ?????????S
  (???f??a?t??? p??e??e????t??? se s??d??µa ?aµ????
  ?a?d?a??? pa????? ? se a??e?t???? st??
  a?t?a????µ??? a???? ?????a??? a????µ?e? ?a?
  µete??e????t??? se ?a?d???e?? ?atap????a)

14
????????S ????T???S?S ??????????S ??????S(3)

• S? ??????????S ??????S??S ?????????OS?S (Se
  s?ßa?? d?s?e?t?????a t?? a??ste??? ?????a?, se
  s?µp???e? ß??ße? t?? stefa??a??? a??e??? ?a? se
  a?µ?d??aµ??? asta?e?? as?e?e?? µe ?µf?a?µa t??
  µ???a?d???)

15
????????S ????T???S?S ??????????S ??????S(4)

• S? ?ST????S ?? ?????? ???????? ??????????
  ?????F???S G?? ??????S???S? ???? ??? ????T???S?
  ??????S ??? ??????S S?S????S ????????S
  ??????T?S?S
• S? ?ST????S ?? ?????F??G?????? S??T?G??
• S? ???????S ????????S ????T???S ??? ???????????
  S? ?S?????? ??? ??????????

16
???????????S ????T???S?S ??????????S ??????S

• S????? ?????????? ???????S ???????S
• ????O??S???? ??????S?? ?????S
• S????? ????F????? ?GG????? ??S?S (G?? ??
  ?????????? ????T???S? ??? ?? ??????? ???????)
• S????? ??? ?????? ?G??F????? ?????

17
??????? ????T???S?S ??????????S ??????S
18
(No Transcript)
19
(No Transcript)
20
??????? ??????????S ????T???S?S

• ????T???S? S???TOS ??? ??S ?????S ???????S
  ???????S
• ?????G? ??T????? ?S??? 8,5-9,5 F
• ???G??S ???????????S ??? ????????S ????F????O?
  ?GG??O?
• ?????? ?F????G? ????S????S ??? ?????? ??
  ???S????O???? ?????
• ?????????S? ??S ?????S ???????S ???????S ???OT??
  ??? ????O????? S????S??? ??? GO??? 45 ????O?

21
??????? ??????????S ????T???S?S

• ??S?GOG? ??? ???G?? S??????S ??? ??S ??????S ???
  ???OT?S? ??? ????? ??? ??????S? TO?????? ?????
• ?F????S? ??S ??????S ??? ??S?GOG? ??? ???S?????
• ?F????S? ??? ???S????? ??? ??S?GOG? ??? T???????
• ??????F?S? ??? ???? ??? ??????????? ?S??? ??
  S???GG? ?O? 60 ML
• ??S?GOG? ??? ???OT?S? ??? ??T????? ??? ?S??? ???
  ??? T??????? ????? ????F????????? ??S ??F?S?S ??S
  ???S????S ??????????? ???????S
• ????????OS? T?S?S ?S??Y ?? ??????G??F?? TO????S
• ?F????S? ???G?? S??????S
• ??T??OS? ?? ??????? ??? ??O??????? ???????S ???
  ?S???

22
S????S? ??? ?S??? ?? ??? ???????? ???S???

• ???????S??S ??? ????????? ????? ??? ?S??? ??
  ?????? ??????? ???????S (5000 IU ???????S S?
  500ML F?S????G???? ?????) , S????S? ?? TRANSDUCER
  KAI ??T??????S? ??? ??? ???????? ?T???
• S????S? ??? ????????? ????? ??S ???S?S, ??? ?????
  ??? ?S??? ??? ??? ?????????????G??F?????S ?? ??S
  ????S?????S ???????S ??? ??????????S
• ??????? ??? ?S??? ?? ????
• ??T??S? ??? ???T?????? ??T??? ???S??????S
  ??????S?S (AUGMENTATION)
• ?????? ???????G??S

23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
S?G?????S??S ??S ??????S

• ?????G???? ??? ???????G?? 12 (??????? ??? ?S???
  ??? ??????? ???????? ?????)
• ??T??S? ??S ???????S ??? ?S???(INFLATION) ???OS
  OS?? ?? ??????? S?? ????????? ?????? ??? ??????S
  ???????S ???S?S
• ??T??S? ??S S???????S ??? ?S??? (DEFLATION) ???OS
  OS?? ?? S???????? ?? ?? ?????? R ???
  ?????????????G??F?????S
• S? ????T???S T?????? ?? ???????? S??? ?????G? ??S
  ????????S ???????G??S ???OS OS?? ? S??????? ???
  ?S??? ?? S???????? ??T? F??? ?? ?? ???? R
• S? ??????????S? ???S?????? ?????G? ??S ???GOG?S
  ??S?? ??S ?????S S?G?????????? ? ?????? G?? ??
  ??? ???????????? ?? SPIKE OS ???? R

27
(No Transcript)
28
??O??? ???????
?????OS??S ??O??? S?G????S? ??S ???????S
???????S ??T?N?
????S? ?O? LVEDV,LVEDP ??? PAWP
????S? ????F?????? ???
????O??????S ??S?S ?????????? ???????S
???????S ????S?
???????????S ???????OS?S ?2
29
????? ???????
?????OS??S ????????S ?????S? ?O? S??F?????O?
?GG??O?
30
??O??? S???????
?????OS??S ????????S ?????S? ?O?
S??F??????O?
???????? ?????????? ??? S??S
???O????S ??? ?? S??F?????? ?GG???

????????S ???OS? ??? ????F?????? ??S ???S????S
??????S
????S? ??S ???????????S ???????OS?S ?2
31
????? S???????
?????OS??S ????S?? ???OS?S ? ????? ??? ????S?
??? ????F?????? ????S? ??S ???????????S
???????OS?S ?2
32
????????S

• ?S?????? ??? ?????S (??????? ??S???S ??T?????
  ??? ???? ????? ??????? ??????? ?? SOS?? ??G?T?S
  ??T????? ??? ?F????G? ???????S ???????????S
  ?GOG?S)
• ????O??S??S ???????S ? ??G????? ???. ? ?????S
  (??????? ???F?G? ???S?S S?????? ???G?? S??????S
  ??? ???OT?S?S ??? ???? S????????? ????S??S?)
• ????OS? ??? ????? (???F?G? ????T???S?S ??T?????
  S? ??????????S? ?????????T???)
• ?GG????? ?G??F????? ????S????? (??????? ???F?G?
  ????T???S?S ??? ?S??? ???? ???????? ??? ?????S
  ?????S?S ??? ????????? ????? ???)
• S??? (??????? SOS?? ????S???? ???? ???
  ????T???S?, ???? ??T??????? ????????S? ???
  S?????? ??S???? S?? ????? ??? ???F?G? ???? ??
  ?????? ????????S ??? ?S??? ??? ??????)
• ???? ??? ?S??? ??? S?S???????? ?????? ?????

33
?F????S? ??? ??????????? ?S???

• S???????S ???G??????S??S ??? ?ST????S ?? ???
  ?????? S? ???????G?? 1/2 ,1/3, 1/4
• ???????S ??? ????????????S ???G??S ??? ?ST????S
  S? ??T? F?S?
• ??????? ????F?????S ????G?S?S ???????S 4 O??S ???
  ??S ?F????S?OS
• ???G??S ??? APTT ??? ?ST????S
• ??????? ???????G??S ????OT?S?S (ASSIST STANDBY)
• ??????F?S? ??? ?????? ??? ?S???
• ?????? ???S??S? ??? ??T????? ??? ?S???
• ?F????S? ??????O?
• ?F????S? T??????? ??? ?S??? OS ?????? SO??
• S??T??? ?F????G? ???S?S S?? S????? ??S???? G?? 30
  ??????? MIN ??? ???? ???S???? ??????S? ???
  ??????????

34
S?S???? ??OSO??????S ?????F????S ??? ???G??OS?S
35
???????? ???????? ???S????????OSO??????
???G??OS?
36
????????S ????T???S?S S?S????S ??OSO??????S
?????F????S

• ?????????? ???? ??? ??? ??F??G?? ??????????
• ?????????? ???? ??? ??????????????
• ???F???????? ???? ??? ??????S??S ?????????OS?OS
  (???t?µ?ta? s?????? ? IABP)
• ???F???????? ?????????? ??T?????? S?? ??????
  F??????????? ??? ???S????????? ?GOG?
• ??????G?? ???G??S
• S????? ????? ? ?????? ?? ?????????????? ????????
  ?????????? OS G?F??? G?? ??????S???S? ? G??
  ????T???S? ????S ??????S S?S????S ????????S
  ??????T?S?S

37
???????????S ????T???S?S S?S????S ??OSOS??????S
?????F????S

• S????? ????F????? ?GG????? ??S?S
• ???SF??? ?GG????? ?G??F????? ????S????? ?
  ???????G??F????? ???OS?
• ?????????S ????OS
• ????G?S ???????G??
• ?????? ??S?S
• ???????????? ???????
• S?????? ??T??? ?????????? ???????S ???????S

38
??????? ????T???S?S

• ??S?GOG? T?????O? (7 ? 8 Fr) ?? ?? ??T???
  SELDINGER S??? ????? ??????? ??????? ??? F????
  (???O ??? ?? ????O???? S????S??)
• ????G?S? ???????S (225 IU/KGR)
• ??S?GOG? ????????? S??????S ??S S?S????S??S
• ?F????S? T???????
• ??S?GOG? ???S?????
• ?F????S? ????????? S??????S ??? ??S?GOG? ????????
  ??? ??? ???S?????
• ?F????S? ??????? ???S????? (8Fr) ??? ?????????
  ??S?GOG? ???S????O? 12 ??? 14 Fr
• ????? ????????? ????
• ?F????S? ???S????? 14 Fr ??? ??S?GOG? ??? SO????
  (CANNULA) ?O? 18 Fr
• ?F????G? ?????G?S ???????S??S G?? ?? CANNULATION
  ??S ?????S ???????S F????S
• S????S? ?? ?? S?S???? ????????????????S
  ?????????S
• ??T??????S? ??? ?????? ???????G??S S?S????S ???
  ?????? ??OSO????S??

39
???????G?? ??S S?S????S

• ??????F?S? ??? ??????S ??? ??? CANNULA ??S ?????S
  ???????S F????S (???? ??? ?? ????? ?????)
• S?S???? T??????S ??T??S?S
• ?????S? S??? ???????? ?????? ??? ???????????
  ???G??O??
• ??S???S ??? ??????S ??? ??? ?????????? SO???? S??
  S?S???????? ????F????

40
F?S????G?? ???? ??? ???????????????? ?????????

• ???OS? F??????S ???S???F?S
• ???OS? ???S?????O? ?????????O? ???S?O?
• ???OS? ???S?S ??SF??OS?S ?????????O? ????????O?
• ???OS?S ??S ???????S ??OT?S?S ??? ??? ???S????
  ?????? ??? ????? ???OS? ??S S?S????????S
  ?????????S ???S?S (S???? ???G?? ????G?S?S
  ???S????????O? ????????O? ??? ???S????S)
• ???????? ??????S 5-6 Lt/min (?????GOS ???
  ??G?T??S ?O? SO???O?)
• ???OS? ???S??S?O? ?O? ???S???O? ???????O?
  ????????O? ??? ??????OS ??S ????O??????S ??S?S
  ??? ??S ???????????S ???????OS?S ???G????

41
?????????T?S? ??? ?ST????S ??? ???S????? S?
???????????????? ?????????

• S?????S ?????S? ?????????S ???S?OS
• S?????S ?????????T?S? ?????????O? ???S?O?
• ??????? ?????S? ???S?S ??SF??OS?S ?????????O?
  ????????O?
• ???G??S F?????O? G????O? ??? ????O???OS ???OS
  ?S?? ?? ?????????? ????S??S ???S ??? ????SF??????
  ????
• S?????S ???????S??S ?? ACT ??G??????? ?O? 400 sec
• ???????S ???G??S ????O? ?????????? ??????S
• ???????S ???G??S ????S??? ??????S ??????????S
  ???????S

42
????????S

• ???????G?? ??? ?? S????? ??S???? ?O? SO???O?
  ???OS ???? ??? ?F????S? ???S (??????? ?? S???????
  ???OS? ??S ????G??????S ???????S 3 O??S ??? ??S
  ?F????S?S)
• ????????? ????O?? ? ????OS?
• ??OS? ???????? ??????
• G?S?????????? ???????G??
• ??????????
• ?? ?O ??T?? F????T????OS?
• ???????? ?S??????? ?GG????? ?G??F????? ????S????
• S?S???????? ?????? ????
• ???????? ?????S???S?S ??? ?? S?S????

43
F?G???????S ??????S

• ????????? S?S????S ???S??????S ??S ???S ? ??? ?O?
  ??? ?????O? ??? ????? ???? ???????? S?S?????? ?
  ??????? S?S???O? ??OSO??????S ?????F????S
• ???? ???S ???F????????S ?????S ??? S?????S???S
  ??? ???F????? S???????? ?????? ???S ?S?? ?F??? ??
  ???????S????
• ? ???????G?? ???S S????????? S?? ??????S?
  ????S???F???S ????S?S ??? ????????? ???S????,
  ????????S ? S?G?????????S ?O???S
• ?? ????????S ????T???S?S ???S ????? ?????G?S
  ???O? ?O? S?S???O? ??OSO??????S ?????F????S ????
  ??? ?????????? ??OSO?????? ???G??OS?
• ?? ????????S ??S ????T???S?S ???S ????? ?
  ???????G??, ? ??F???? ??????????,?? ????O???S, ?
  ?????????? ???????, ?? ?G??F????? ????S???? ???
  ?? S?S????????S ??????S
• ????? ?????OS? ???? ??? ????T???S? ???S 21-41

44
(No Transcript)
45
F?G???????S ?????? LEVITRONICS
46
S?S????S ?????S ? ??????S ????????S ??????T?S?S
47
? ????T???S? ???S ??? ?F??? ??? ??????
????????S T???????S

• ? ?????? ????????S T???????S ??????????? ???
  ??????? ??? ?????????T?S? ?O? ?ST??O? ??? F?????
  S?S????S ??????S ????????S ??????T?S?S

48
S?S????S S??????S ???S

• S?S????S ???????S ???S

49
????????S

• S??????? ??????S ????????S ??????S (S????? 3
  ? 4 ????????S ??????????S ???? ?? ?????S??
  F??????????? ?GOG?, ????????S ??????S ?????????S
  ??? 2L/MIN/M2, PAWP ??O ?O? 20 mmHg) OS G?F???
  G?? ??????S???S? ??????S (BRIDGE TO
  TRANSPLANTATION) , OS G?F??? G?? ????? ?????OS?
  ??? ?????????? (BRIDGE TO RECOVERY) KAI OS ??????
  ??? ???S???? T??????? (DESTINATION THERAPY)

50
?????G? ?????????S S?S????S ????????S ??????T?S?S

?p? N.Engl J.Med 357846, August 30,2007
51
????G????S ??? ??????????? ??S???OS ??? ????S?
???? ??? ???????G??? ??F????S? LVAD, RVAD ? BVAD

• ????G?????? ????T???S? VAD
• ????G?T?? ??? ??F??G?? ??? ??????????
• ???????? F?????? ???S? ??O ?O? 16 mmHg
• ???????? ???S?????? ??S ???????S ????G??????????
• ?S??????? ???????????T???
• ?????S ???T???????S ????????????S ??O ?O? 16 sec

52
LVAD HEART MATE I
53
HEART MATE II LVAD
54
TOTAL ARTIFICIAL HEARTJARVIC 7 ??? ABIOCOR
55
S??????S????

• ?? S?S????S ????????S ??????T?S?S ?????????
  ???S??? ???? S??? ???????O??S? ?O? S??????O?
  ??????S ??????S ???? ????????T?S?? ????
  ????????T?S??
• ? ?????????? ?????? ????OT?S?OS OS ??? ????
  ???????O???? ??S? ???S??????S ??S ???S????S
  ??????S ???????? ???? ?????S?? ????? ???SO????S
  ???S??????S ?ST??O? S?? ?????? ????????S
  T???????S
• S? S????? ???O????S ???????????S ?F?????S ? IABP
  ?????? ?? ??? ??????? ??? ??T?S????? ???G???? ?
  ???S? S?S???O? ????????S ? ????????????????S
  ?????????S
• ?? ???????G??? ??F????S???S S?S????S ?????S ?
  ??????S ????????S ??????T?S?S ????T???????? S?
  ?ST????S ?? ????? ? ?????? ?? ?????????????
  ???????? ?????????? OS G?F???S G?? ??????S???S?,
  G?? ?????OS? ? OS ???S???? T???????
• ? ????????? ??? ? ?????? G?? ???????? S??? ?????
  ??S ????????S ????????S ????????S ??????T?S?S
  ???????? ??? ???? ?????? ????? ??????? ?????? ???
  T? ???OS?? S???????? ??? ????? T???????? ???
  ???????? ?????????? ??? ??S ???G??S G?? ????????
  ??S???????