Kamdar Forum, Boyle Andrew, Liao Kenneth, Colvin-adams Monica, Joyce Lyle, John Ranjit
Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
J Heart Lung Transplant. 2009 Apr;28(4):352-9. doi: 10.1016/j.healun.2009.01.005.
Newer continuous-flow left ventricular assist devices (LVAD) have the advantage of smaller size and increased durability. Questions remain regarding the safety and effects of long-term nonpulsatile flow, despite some animal and human studies showing that end-organ function is well maintained with pulsatile or axial-flow devices. This study investigated whether centrifugal devices have similar effects on end-organ function.
All patients who underwent LVAD implantation as bridge-to-transplant (BTT) therapy from January 2004 through May 2007 were reviewed. Excluded were patients on biventricular support, destination therapy, temporary support, and patients who died within 30 days after LVAD implantation. The centrifugal device was the VentrAssist (Ventracor Ltd, Sydney, Australia); axial, the HeartMate II; and pulsatile, the HeartMate XVE (Thoratec Corp, Pleasanton, CA).
During the study, 10 VentrAssist, 30 HeartMate II, and 18 HeartMate XVE devices were implanted. Among the 3 groups, age, gender, weight, duration of LVAD support, and cause of heart failure were comparable. No significant differences were found between groups with respect to baseline renal function, hepatic function, or hematologic function. At 1 and 3 months of follow-up, renal and hepatic function either improved or remained within normal limits in all groups.
Centrifugal, axial, and pulsatile LVADs all provide adequate circulatory support to maintain appropriate end-organ function in patients with end-stage heart failure. The advantages of the newer continuous-flow devices can be safely applied to an increasing number of patients. Long-term studies (>1 year) are needed to assess effects on end-organ function with continuous-flow devices, which may have important implications for use as destination therapy.
新型连续流左心室辅助装置（LVAD）具有体积更小、耐用性更强的优点。尽管一些动物和人体研究表明，搏动流或轴流装置能很好地维持终末器官功能，但长期非搏动流的安全性和影响仍存在疑问。本研究调查了离心式装置对终末器官功能是否有类似影响。
回顾了2004年1月至2007年5月期间接受LVAD植入作为过渡到移植（BTT）治疗的所有患者。排除接受双心室支持、目标治疗、临时支持的患者以及LVAD植入后30天内死亡的患者。离心式装置为VentrAssist（澳大利亚悉尼的Ventracor有限公司）；轴流式为HeartMate II；搏动式为HeartMate XVE（加利福尼亚州普莱森顿的Thoratec公司）。
研究期间，植入了10个VentrAssist装置、30个HeartMate II装置和18个HeartMate XVE装置。三组患者在年龄、性别、体重、LVAD支持时间和心力衰竭病因方面具有可比性。各组在基线肾功能、肝功能或血液学功能方面未发现显著差异。在随访1个月和3个月时，所有组的肾功能和肝功能均有所改善或保持在正常范围内。
离心式、轴流式和搏动式LVAD均能提供足够的循环支持，以维持终末期心力衰竭患者适当的终末器官功能。新型连续流装置的优点可以安全地应用于越来越多的患者。需要进行长期研究（>1年）来评估连续流装置对终末器官功能的影响，这可能对作为目标治疗的应用具有重要意义。
