Welp H, Rukosujew A, Tjan T D T, Hoffmeier A, Kösek V, Scheld H H, Drees G
Department of Thoracic and Cardiovascular Surgery, University Hospital, Albert-Schweitzer-Strasse 33, Muenster, Germany.
Thorac Cardiovasc Surg. 2010 Feb;58 Suppl 2:S185-8. doi: 10.1055/s-0029-1240709. Epub 2010 Jan 25.
Left ventricular assist devices have been successfully used as a bridge to cardiac transplantation. Because many patients exhibit marked clinical improvement of their heart failure after LVAD implantation, we studied the physiological effect of pulsatile and non-pulsatile devices on the neurohormonal axis and exercise capacity.
We prospectively included 20 patients (17 men, 3 women) undergoing LVAD implantation between November 2001 and January 2004. Ten patients (1 woman and 9 men) were treated with the non-pulsatile INCOR-LVAD (Berlin Heart(c)) and ten patients received the pulsatile EXCOR LVAD (Berlin Heart(c)). Blood samples for plasma renin activity (PRA) were taken once a week over a period of ten weeks. All blood samples were collected in the morning before mobilization. Blood pressure, body weight, fluid intake and urine production were measured once a day. All patients received standard hospital diet with no limitation in fluid intake.
Body weight remained constant in both groups throughout the ten weeks' examination, and fluid intake and urine production were balanced in all patients. Although there was no significant difference in mean blood pressure (INCOR: 70 +/- 10 mmHg; EXCOR: 73 +/- 10 mmHg), plasma renin activity was substantially elevated in patients with non-pulsatile left ventricular support (INCOR: 94.68 +/- 33.97 microU/ml; EXCOR: 17.06 +/- 15.94 microU/ml; P < 0.05). Furthermore plasma aldosterone levels were significantly higher in patients supported by non-pulsatile INCOR LVAD (INCOR: 73.4 +/- 9.6 microg/ml; EXCOR: 20.6 +/- 4.6 microg/ml; P < 0.05).
Our data suggest that pulsatile as well as non-pulsatile left ventricular assist devices are equally able to treat chronic heart failure. However pulsatile devices seem to have a greater impact on reversing the changes in plasma renin activity and might thus offer a greater advantage when recovery of left ventricular function is expected.
左心室辅助装置已成功用作心脏移植的桥梁。由于许多患者在植入左心室辅助装置后心力衰竭的临床症状有显著改善，我们研究了搏动性和非搏动性装置对神经激素轴和运动能力的生理影响。
我们前瞻性纳入了2001年11月至2004年1月期间接受左心室辅助装置植入的20例患者（17例男性，3例女性）。10例患者（1例女性和9例男性）接受非搏动性INCOR左心室辅助装置（柏林心脏公司）治疗，10例患者接受搏动性EXCOR左心室辅助装置（柏林心脏公司）治疗。在为期十周的时间里，每周采集一次用于检测血浆肾素活性（PRA）的血样。所有血样均在早晨活动前采集。每天测量血压、体重、液体摄入量和尿量。所有患者均接受标准医院饮食，液体摄入量无限制。
在为期十周的检查中，两组患者的体重均保持恒定，所有患者的液体摄入量和尿量保持平衡。尽管平均血压无显著差异（INCOR：70±10 mmHg；EXCOR：73±10 mmHg），但非搏动性左心室支持患者的血浆肾素活性显著升高（INCOR：94.68±33.97微单位/毫升；EXCOR：17.06±15.94微单位/毫升；P<0.05）。此外，接受非搏动性INCOR左心室辅助装置支持的患者血浆醛固酮水平显著更高（INCOR：73.4±9.6微克/毫升；EXCOR：20.6±4.6微克/毫升；P<0.05）。
我们的数据表明，搏动性和非搏动性左心室辅助装置在治疗慢性心力衰竭方面同样有效。然而，搏动性装置似乎对逆转血浆肾素活性变化有更大影响，因此在预期左心室功能恢复时可能具有更大优势。
