Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA.
Circulation. 2009 Dec 8;120(23):2352-7. doi: 10.1161/CIRCULATIONAHA.108.814863. Epub 2009 Nov 23.
The effects of continuous blood flow and reduced pulsatility on major organ function have not been studied in detail.
We evaluated renal (creatinine and blood urea nitrogen) and hepatic (aspartate transaminase, alanine transaminase, and total bilirubin) function in 309 (235 male, 74 female) advanced heart failure patients who had been supported with the HeartMate II continuous-flow left ventricular assist device for bridge to transplantation. To determine whether patients with impaired renal and hepatic function improve over time with continuous-flow left ventricular assist device support or whether there are any detrimental effects in patients with normal organ function, we divided patients into those with above-normal and normal laboratory values before implantation and measured blood chemistry over time during left ventricular assist device support. There were significant improvements over 6 months in all parameters in the above-normal groups, with values in the normal groups remaining in the normal range over time. Mean blood urea nitrogen and serum creatinine in the above-normal groups decreased significantly from 37+/-14 to 23+/-10 mg/dL (P<0.0001) and from 1.8+/-0.4 to 1.4+/-0.8 mg/dL (P<0.01), respectively. There were decreases in aspartate transaminase and alanine transaminase in the above-normal groups from 121+/-206 and 171+/-348 to 36+/-19 and 31+/-22 IU (P<0.001), respectively. Total bilirubin for the above-normal group was 2.1+/-0.9 mg/dL at baseline; after an acute increase at week 1, it decreased to 0.9+/-0.5 mg/dL by 6 months (P<0.0001). Both renal and liver values from patients in the normal groups remained normal during support with the left ventricular assist device.
The HeartMate II continuous-flow left ventricular assist device improves renal and hepatic function in advanced heart failure patients who are being bridged to transplantation, without evidence of detrimental effects from reduced pulsatility over a 6-month time period.
连续血流和降低脉动对主要器官功能的影响尚未得到详细研究。
我们评估了 309 例（235 例男性，74 例女性）接受 HeartMate II 连续血流左心室辅助装置桥接移植的晚期心力衰竭患者的肾功能（肌酐和血尿素氮）和肝功能（天门冬氨酸氨基转移酶、丙氨酸氨基转移酶和总胆红素）。为了确定随着连续血流左心室辅助装置的支持，肾功能和肝功能受损的患者是否会随着时间的推移而改善，或者在正常器官功能的患者中是否存在任何不利影响，我们将患者分为植入前实验室值高于正常和正常的患者，并在左心室辅助装置支持期间随时间测量血液化学。在上述正常组中，所有参数在 6 个月内均有显著改善，正常组的正常值随时间保持不变。上述正常组的平均血尿素氮和血清肌酐分别从 37+/-14 降至 23+/-10mg/dL（P<0.0001）和从 1.8+/-0.4 降至 1.4+/-0.8mg/dL（P<0.01）。上述正常组的天门冬氨酸氨基转移酶和丙氨酸氨基转移酶分别从 121+/-206 和 171+/-348 降至 36+/-19 和 31+/-22IU（P<0.001）。上述正常组的总胆红素基线值为 2.1+/-0.9mg/dL；第 1 周急性增加后，6 个月时降至 0.9+/-0.5mg/dL（P<0.0001）。左心室辅助装置支持期间，正常组患者的肾和肝功能值均保持正常。
HeartMate II 连续血流左心室辅助装置可改善桥接移植的晚期心力衰竭患者的肾功能和肝功能，在 6 个月的时间内没有证据表明降低脉动对其产生有害影响。
