Division of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
J Heart Lung Transplant. 2010 Oct;29(10):1172-6. doi: 10.1016/j.healun.2010.05.018. Epub 2010 Jul 8.
Left ventricular assist devices (LVADs) are increasingly used as long-term therapy for end-stage heart failure patients. We compared the prevalence of aortic insufficiency (AI) after HeartMate II (HMII) vs HeartMate XVE (HMI) support and assessed the role of aortic root diameter and aortic valve opening in the development of AI.
Pre-operative and post-operative echocardiograms of 93 HMI and 73 HMII patients who received implants at our center between January 2004 and September 2009 were retrospectively reviewed. After excluding patients with prior or concurrent surgical manipulation of the aortic valve, with baseline AI, or without baseline echoes, 67 HMI and 63 HMII patients were studied. AI was deemed significant if mild to moderate or greater. Pathology reports were reviewed for 77 patients who underwent heart transplant.
AI developed in 4 of 67 HMI (6.0%) and in 9 of 63 HMII patients (14.3%). The median times to AI development were 48 days for HMI patients and 90 days for HMII patients. For patients who remained on device support at 6 and 12 months, freedom from AI was 94.5% and 88.9% in HMI patients and 83.6% and 75.2% in HMII patients (log rank p = 0.194). Aortic root diameters, as determined by echocardiography for the patients with AI, trended to be larger at baseline (3.43 ± 0.43 vs 3.15 ± 0.40; p = 0.067) and follow-up (3.58 ± 0.54 vs 3.29 ± 0.50; p = 0.130) compared with those who did not have AI. Aortic root circumferences were assessed directly by a pathologist in those patients who underwent transplant and were significantly larger in HMII patients who had developed AI compared with those patients who did not (8.44 ± 0.89 vs 7.36 ± 1.02 cm; p = 0.034). Lastly, AI was more common in patients whose aortic valve did not open (11 of 26 vs 1 of 14; p = 0.03).
Aortic insufficiency occurs frequently in patients who receive continuous-flow support with a HMII LVAD, and may be associated with aortic root diameter enlargement and aortic valve opening. These findings warrant a more thorough preoperative patient evaluation and additional studies to investigate the factors, that may be associated with AI development.
左心室辅助装置（LVAD）越来越多地被用作终末期心力衰竭患者的长期治疗方法。我们比较了 HeartMate II（HMII）和 HeartMate XVE（HMI）支持后的主动脉瓣关闭不全（AI）的发生率，并评估了主动脉根部直径和主动脉瓣开口在 AI 发展中的作用。
回顾性分析 2004 年 1 月至 2009 年 9 月期间在我们中心接受植入的 93 例 HMI 和 73 例 HMII 患者的术前和术后超声心动图。排除了主动脉瓣术前或同期手术操作、基线 AI 或无基线回声的患者后，研究了 67 例 HMI 和 63 例 HMII 患者。如果 AI 为轻度至中度或更严重，则认为 AI 是显著的。对 77 例接受心脏移植的患者进行了病理报告回顾。
4 例（6.0%）67 例 HMI 患者和 9 例（14.3%）63 例 HMII 患者出现 AI。HMI 患者的 AI 中位发生时间为 48 天，HMII 患者为 90 天。在仍接受设备支持的患者中，6 个月和 12 个月时，HMI 患者的 AI 无进展生存率分别为 94.5%和 88.9%，HMII 患者分别为 83.6%和 75.2%（对数秩检验，p=0.194）。在 AI 患者中，超声心动图测量的主动脉根部直径在基线时（3.43±0.43 比 3.15±0.40；p=0.067）和随访时（3.58±0.54 比 3.29±0.50；p=0.130）趋于更大，而在没有 AI 的患者中则更小。在接受移植的患者中，直接由病理学家评估主动脉根部周长，发现 HMII 患者的 AI 更常见，主动脉根部周长明显大于无 AI 的患者（8.44±0.89 比 7.36±1.02cm；p=0.034）。最后，主动脉瓣未开放的患者 AI 更为常见（26 例中有 11 例，14 例中有 1 例；p=0.03）。
HMII LVAD 持续血流支持的患者中，主动脉瓣关闭不全发生率较高，可能与主动脉根部直径增大和主动脉瓣开放有关。这些发现需要更彻底的术前患者评估，并进行额外的研究，以调查可能与 AI 发展相关的因素。
