Department of Cardiovascular Surgery, Tokyo Women's Medical University, Japan.
ASAIO J. 2012 Jul-Aug;58(4):402-6. doi: 10.1097/MAT.0b013e31825b9826.
Previous studies have demonstrated that left ventricular assist device (LVAD) implantation significantly decreases myocyte size and reduces fibrosis of the left ventricle (LV). The objectives of the present study were to evaluate LV functional recovery after LVAD implantation and to assess its predictive factors, including histological findings of LV. Six patients with idiopathic cardiomyopathy underwent LVAD support with an EVAHEART implantable centrifugal pump (Sun Medical Technology Research, Nagano, Japan) for an average support duration of 2.91 years. Histologic samples were obtained from their LV apexes at the time of implantation. At 1 month and at 24 months after implantation, brain natriuretic peptide (BNP) and echocardiographic parameters were evaluated. Brain natriuretic peptide values, LV end-diastolic dimension, LV end-systolic dimension, functional shortening, and right ventricular systolic pressure (RVSP) were improved after LVAD implantation. Patients with developing fibrosis had longer durations of heart-failure history and higher pulmonary artery pressures. Patients with hypertrophic myocytes had smaller FS preoperatively. There was a correlation between the amount of fibrosis and the rate of BNP value change after LVAD implantation. In patients with less fibrosis and smaller myocytes preoperatively, improvement in LV function was observed during LVAD support.
先前的研究表明，左心室辅助装置（LVAD）的植入显著减小心肌细胞的大小，并减少左心室（LV）的纤维化。本研究的目的是评估 LVAD 植入后的 LV 功能恢复情况，并评估其预测因素，包括 LV 的组织学发现。6 名特发性心肌病患者接受了 EVAHEART 植入式离心泵（日本长野县 Sun Medical Technology Research）的 LVAD 支持，平均支持时间为 2.91 年。在植入时从他们的 LV 顶点获得组织学样本。在植入后 1 个月和 24 个月时，评估了脑钠肽（BNP）和超声心动图参数。植入 LVAD 后，BNP 值、LV 舒张末期内径、LV 收缩末期内径、功能缩短和右心室收缩压（RVSP）得到改善。发生纤维化的患者心力衰竭病史较长，肺动脉压较高。术前心肌肥厚患者的 FS 较小。纤维化的量与 LVAD 植入后 BNP 值变化的比率之间存在相关性。在术前纤维化程度较轻且心肌细胞较小的患者中，LVAD 支持期间 LV 功能得到改善。
