Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
Ann Thorac Surg. 2011 Mar;91(3):750-4. doi: 10.1016/j.athoracsur.2010.11.012.
Placement of a ventricular assist device (VAD) may lead to reduced or absent opening of the aortic valve and thus increase risk of thrombus formation in the aortic root as well as on the valve itself. The outcome of additional procedures to the aortic valve at the time of VAD placement is unclear.
A retrospective analysis of 712 VAD patients from 1995 to 2009 was performed.
Twenty-eight patients were identified who underwent aortic valve procedures in addition to VAD placement. Indication for VAD placement was bridge to transplant in 23 patients, destination therapy in 4, and postcardiotomy shock in 1. Aortic valve procedures were performed for preexisting mechanical aortic prosthesis in 8 (7 closure and 1 aortic valve replacement with biological prosthesis), and for moderate or severe aortic insufficiency in 20 patients (10 repair, 9 closure, and 1 aortic valve replacement with biological prosthesis). At the last follow-up, 16 patients had undergone heart transplant, 6 remained on VAD support, and 5 had died. While on VAD support, no adverse events related to the aortic valve procedures occurred. The 30-day operative mortality was 0.4%. No clinical thromboembolic events were observed. In 2 patients, there was evidence of thrombus formation in the explanted heart. Four patients had bleeding complications. Of the 9 patients who received aortic valve repair, 2 had recurrent aortic insufficiency on echocardiograms during an average follow-up of 118 days.
Additional procedures to the aortic valve at the time of VAD placement are feasible. Overall outcomes are comparable to those seen in patients without the need for aortic valve manipulation at the time of VAD placement.
心室辅助装置（VAD）的放置可能导致主动脉瓣开放减少或消失，从而增加主动脉根部和瓣叶本身血栓形成的风险。在 VAD 放置时对主动脉瓣进行额外手术的结果尚不清楚。
对 1995 年至 2009 年的 712 例 VAD 患者进行回顾性分析。
确定了 28 例患者在接受 VAD 放置的同时还进行了主动脉瓣手术。VAD 放置的适应证为桥接移植 23 例，目的地治疗 4 例，心脏手术后休克 1 例。主动脉瓣手术的指征为 8 例患者存在先前的机械主动脉瓣假体（7 例为瓣环关闭，1 例为生物瓣主动脉瓣置换），20 例患者存在中度或重度主动脉瓣关闭不全（10 例为修复，9 例为瓣环关闭，1 例为生物瓣主动脉瓣置换）。最后一次随访时，16 例患者接受了心脏移植，6 例仍在接受 VAD 支持，5 例死亡。在接受 VAD 支持期间，与主动脉瓣手术相关的不良事件未发生。30 天手术死亡率为 0.4%。未观察到临床血栓栓塞事件。在 2 例患者中，在取出的心脏中发现有血栓形成的证据。4 例患者出现出血并发症。在接受主动脉瓣修复的 9 例患者中，2 例在平均 118 天的随访中经超声心动图检查发现主动脉瓣关闭不全复发。
在 VAD 放置时对主动脉瓣进行额外手术是可行的。总体结果与 VAD 放置时无需对主动脉瓣进行操作的患者相似。
