左心室辅助装置植入术后的右心功能障碍：搏动性HeartMate I与轴流式HeartMate II装置的比较

Right heart dysfunction after left ventricular assist device implantation: a comparison of the pulsatile HeartMate I and axial-flow HeartMate II devices.

作者信息

Patel Nishant D, Weiss Eric S, Schaffer Justin, Ullrich Susan L, Rivard Dennis C, Shah Ashish S, Russell Stuart D, Conte John V

机构信息

Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.

出版信息

Ann Thorac Surg. 2008 Sep;86(3):832-40; discussion 832-40. doi: 10.1016/j.athoracsur.2008.05.016.

DOI:10.1016/j.athoracsur.2008.05.016

PMID:18721570

Abstract

BACKGROUND

Right heart dysfunction confers significant morbidity and mortality after left ventricular assist device implantation and historically occurs in as many as a third of patients. It is unknown whether newer axial flow pumps have a different impact on postimplant right heart dysfunction. We compared the incidence of right heart dysfunction after implantation of the pulsatile HeartMate I (XVE) and the continuous flow HeartMate II left ventricular assist device.

METHODS

We retrospectively reviewed patients who underwent HeartMate I or HeartMate II implantation between June 2000 and March 2007. Right heart dysfunction was defined as inotropic/vasodilator support for 14 or more consecutive days or the need for a right ventricular assist device, or both.

RESULTS

Seventy-seven patients underwent HeartMate implantation; 43 received a HeartMate I and 34 received a HeartMate II, for a mean left ventricular assist device support time of 202 and 160 days, respectively. Operative mortality was lower for HeartMate II patients (28% versus 15%; p = 0.26). The HeartMate II patients had lower preoperative right ventricular stroke work index. Pulmonary vascular resistance index, right ventricular stroke work index, and pulmonary and right atrial pressures improved and were similar between groups postoperatively. Overall, right heart dysfunction developed in 35% of HeartMate I patients (15 of 43) and 41% of HeartMate II patients (14 of 34; p = 0.63). Fewer HeartMate II patients (2) than HeartMate I patients (5) required 7 or more days of epinephrine, whereas more HeartMate II patients (7) than HeartMate I patients (5) required 7 or more days of milrinone. Six HeartMate I and 3 HeartMate II patients required right ventricular assist device implantation for right heart failure. Survival was similar (p = 0.7) between groups at, respectively, 3 (63% versus 62%), 6 (58% versus 58%), and 12 months (49% versus 48%).

CONCLUSIONS

Right heart dysfunction is a persistent clinical problem after left ventricular assist device placement. We report the first study comparing the incidence of right heart dysfunction after HeartMate I versus HeartMate II implantation. Although the incidence of right heart dysfunction was similar, fewer HeartMate II patients required right ventricular assist device placement and fewer required pure inotropic support for right heart failure.

摘要

背景

右心功能不全在左心室辅助装置植入后会导致显著的发病率和死亡率，历史上多达三分之一的患者会出现这种情况。尚不清楚新型轴流泵对植入后右心功能不全是否有不同影响。我们比较了搏动性HeartMate I（XVE）和连续流HeartMate II左心室辅助装置植入后右心功能不全的发生率。

方法

我们回顾性分析了2000年6月至2007年3月期间接受HeartMate I或HeartMate II植入的患者。右心功能不全定义为连续14天或更长时间使用正性肌力药/血管扩张剂支持，或需要右心室辅助装置，或两者皆需。

结果

77例患者接受了HeartMate植入；43例接受了HeartMate I，34例接受了HeartMate II，左心室辅助装置的平均支持时间分别为202天和160天。HeartMate II患者的手术死亡率较低（28%对15%；p = 0.26）。HeartMate II患者术前右心室每搏功指数较低。两组患者术后肺血管阻力指数、右心室每搏功指数以及肺和右心房压力均有所改善且相似。总体而言，35%的HeartMate I患者（43例中的15例）和41%的HeartMate II患者（34例中的14例）出现了右心功能不全（p = 0.63）。需要7天或更长时间使用肾上腺素的HeartMate II患者（2例）少于HeartMate I患者（5例），而需要7天或更长时间使用米力农的HeartMate II患者（7例）多于HeartMate I患者（5例）。6例HeartMate I患者和3例HeartMate II患者因右心衰竭需要植入右心室辅助装置。两组在3个月（63%对62%）、6个月（58%对58%）和12个月（49%对48%）时的生存率相似（p = 0.7）。