Division of Cardiovascular Medicine and Section of Cardiac Surgery, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5853, USA.
Circ Heart Fail. 2010 Nov;3(6):668-74. doi: 10.1161/CIRCHEARTFAILURE.109.917765. Epub 2010 Aug 25.
Aortic insufficiency (AI) following left ventricular assist device (LVAD) placement can affect device performance. The aim of this study was to examine AI development following LVAD implantation.
Echocardiograms (n=315) from 78 subjects undergoing HeartMate-XVE (n=25 [32%]) or HeartMate-II (n=53 [68%]) implantations from 2004 to 2008 were reviewed. Studies were obtained preoperatively and at 1, 3, 6, 12, 18, and 24 months after surgery. AI was graded on an interval scale (0=none, 0.5=trivial, 1=mild, 1.5=mild-moderate, 2=moderate, 2.5=moderate-severe, 3=severe), and the change in AI at follow-up was analyzed with significance tests. Kaplan-Meier estimates for freedom from moderate or worse AI at follow-up were generated. Mixed-model linear regression was used to identify correlates of AI progression during LVAD support. The median (25th, 75th percentile) duration of LVAD support was 239 (112, 455) days, and preoperative AI grade was 0.0 (0.0, 0.0). At 6 months, 89±4% of subjects (n=49 at risk) were free from moderate or worse AI, but this was reduced to 74±7% (n=29 at risk) and 49±13% (n=13 at risk) by 12 and 18 months, respectively. Correlates (slope±SE) of AI progression included female sex (0.002±0.001; P=0.01), smaller body surface area (-0.003±0.001 per m(2); P=0.0017), and HeartMate-II model type (0.002±0.001; P=0.039). Correlates (β±SE) of progressive AI on postoperative echocardiogram included increasing aortic sinus diameter (0.04±0.01 per mm; P=0.001), an aortic valve that remained closed (0.42±0.06; P<0.001) or only intermittently opened (0.34±0.09; P<0.001), and lower left ventricular diastolic (-0.002±0.0004 per cm(3); P<0.001) and systolic (-0.002±0.0004 per cm(3); P<0.001) volumes.
AI progresses over time in LVAD-supported patients. As we move toward an era of long-term cardiac support, more studies are needed to determine the clinical significance of these findings.
左心室辅助装置（LVAD）置入后出现主动脉瓣关闭不全（AI）会影响装置性能。本研究旨在观察 LVAD 植入后的 AI 发展情况。
对 2004 年至 2008 年间 78 例接受 HeartMate-XVE（n=25[32%]）或 HeartMate-II（n=53[68%]）植入的患者的 315 次超声心动图进行了回顾性分析。研究获得了术前及术后 1、3、6、12、18 和 24 个月的数据。AI 采用间隔量表分级（0=无，0.5=轻微，1=轻度，1.5=轻度-中度，2=中度，2.5=中度-重度，3=重度），并通过显著性检验分析随访时 AI 的变化。绘制了随访时无中度或更严重 AI 的 Kaplan-Meier 估计值。采用混合模型线性回归确定 LVAD 支持期间 AI 进展的相关因素。LVAD 支持的中位（25 百分位，75 百分位）时间为 239（112，455）天，术前 AI 分级为 0.0（0.0，0.0）。6 个月时，89±4%的患者（n=49 例，有风险）无中度或更严重的 AI，但到 12 个月和 18 个月时，这一比例分别降至 74±7%（n=29 例，有风险）和 49±13%（n=13 例，有风险）。AI 进展的相关因素（斜率±SE）包括女性（0.002±0.001；P=0.01）、较小的体表面积（-0.003±0.001/m2；P=0.0017）和 HeartMate-II 模型类型（0.002±0.001；P=0.039）。术后超声心动图上 AI 进展的相关因素（β±SE）包括主动脉窦直径逐渐增大（0.04±0.01/mm；P=0.001）、主动脉瓣持续关闭（0.42±0.06；P<0.001）或仅间歇性开放（0.34±0.09；P<0.001）以及左心室舒张末期容积（-0.002±0.0004/cm3；P<0.001）和收缩末期容积（-0.002±0.0004/cm3；P<0.001）降低。
在接受 LVAD 支持的患者中，AI 随时间推移而进展。随着我们迈向长期心脏支持的时代，需要更多的研究来确定这些发现的临床意义。
