Ochiai Yoshie, McCarthy Patrick M, Smedira Nicholas G, Banbury Michael K, Navia Jose L, Feng Jingyuan, Hsu Amy P, Yeager Michael L, Buda Tiffany, Hoercher Katherine J, Howard Michael W, Takagaki Masami, Doi Kazuyoshi, Fukamachi Kiyotaka
Department of Biomedical Engineering, Lerner Research Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Circulation. 2002 Sep 24;106(12 Suppl 1):I198-202.
Insertion of an implantable left ventricular assist device (LVAD) complicated by early right ventricular (RV) failure has a poor prognosis and is largely unpredictable. Prediction of RV failure after LVAD placement would lead to more precise patient selection and optimal device selection.
We reviewed data from 245 patients (mean age, 54+/-11 years; 85% male) with 189 HeartMate (77%) and 56 Novacor (23%) LVADs. Ischemic cardiomyopathy predominated (65%), and 29% had dilated cardiomyopathy. Overall, RV assist device (RVAD) support was required after LVAD insertion for 23 patients (9%). We compared clinical and hemodynamic parameters before LVAD insertion between RVAD (n=23) and No-RVAD patients (n=222) to determine preoperative risk factors for severe RV failure. By univariate analysis, female gender, small body surface area, nonischemic etiology, preoperative mechanical ventilation, circulatory support before LVAD insertion, low mean and diastolic pulmonary artery pressures (PAPs), low RV stroke work (RVSW), and low RVSW index (RVSWI) were significantly associated with RVAD use. Elevated PAP and pulmonary vascular resistance were not risk factors. Risk factors by multivariable logistic regression were preoperative circulatory support (odds ratio [OR], 5.3), female gender (OR, 4.5), and nonischemic etiology (OR, 3.3).
The need for circulatory support, female gender, and nonischemic etiology were the most significant predictors for RVAD use after LVAD insertion. Regarding hemodynamics, low PAP and low RVSWI, reflecting low RV contractility, were important parameters. This information may lead to better patient selection for isolated LVAD implantation.
植入式左心室辅助装置（LVAD）植入后并发早期右心室（RV）衰竭预后较差，且很大程度上不可预测。预测LVAD植入后右心室衰竭将有助于更精确地选择患者和优化装置选择。
我们回顾了245例患者（平均年龄54±11岁；85%为男性）的数据，这些患者植入了189个HeartMate LVAD（77%）和56个Novacor LVAD（23%）。缺血性心肌病占主导（65%），29%患有扩张型心肌病。总体而言，23例患者（9%）在LVAD植入后需要右心室辅助装置（RVAD）支持。我们比较了RVAD组（n = 23）和非RVAD组（n = 222）患者LVAD植入前的临床和血流动力学参数，以确定严重右心室衰竭的术前危险因素。单因素分析显示，女性、小体表面积、非缺血性病因、术前机械通气、LVAD植入前的循环支持、低平均和舒张期肺动脉压（PAP）、低右心室搏功（RVSW）和低右心室搏功指数（RVSWI）与RVAD的使用显著相关。PAP和肺血管阻力升高不是危险因素。多变量逻辑回归分析的危险因素为术前循环支持（比值比[OR]，5.3）、女性（OR，4.5）和非缺血性病因（OR，3.3）。
循环支持需求、女性和非缺血性病因是LVAD植入后使用RVAD的最重要预测因素。在血流动力学方面，反映右心室收缩力低的低PAP和低RVSWI是重要参数。这些信息可能有助于更好地选择单纯LVAD植入的患者。
