Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Thorac Cardiovasc Surg. 2013 May;145(5):1373-9. doi: 10.1016/j.jtcvs.2012.11.066. Epub 2013 Jan 8.
Aortic valve regurgitation reduces left ventricular assist device mechanical efficiency. Evidence has also suggested that left ventricular assist device implantation can induce or exacerbate aortic valve regurgitation. However, this has not been compared with aortic valve regurgitation progression in a nonsurgical end-stage heart failure population. Furthermore, its clinical effect is unclear. We sought to characterize the development and progression of aortic valve regurgitation in left ventricular assist device recipients and to identify its clinical effect.
A review of all consecutive patients who received an intracorporeal left ventricular assist device at Duke University Medical Center from January 2004 to January 2011 was conducted. Cases of previous or concomitant aortic valve surgery were excluded. Data from the remaining implants (n = 184) and a control group of contemporaneous nonsurgical patients with end-stage heart failure (n = 132) were analyzed. Serial transthoracic echocardiography was used to characterize aortic valve regurgitation as a function of time.
Left ventricular assist device implantation was associated with worsening aortic valve regurgitation, defined as an increase in aortic valve regurgitation grade, relative to the nonsurgical patients with end-stage heart failure (P < .0001). The recipients of continuous flow left ventricular assist devices were more likely than recipients of pulsatile left ventricular assist devices to develop worsening aortic valve regurgitation (P = .0348). Moderate or severe aortic valve regurgitation developed in 21 left ventricular assist device recipients; this was unrelated to the type of device implanted (continuous vs pulsatile; P = .754) or aortic valve regurgitation grade before left ventricular assist device implantation (P = .42). Five patients developed severe aortic valve regurgitation; all of whom underwent aortic valve procedures.
Native aortic valve regurgitation developed and/or progressed after left ventricular assist device implantation, with this effect being more pronounced in continuous flow left ventricular assist device recipients. However, the preoperative aortic valve regurgitation grade failed to correlate with the development of substantial aortic valve regurgitation after left ventricular assist device implantation. After left ventricular assist device implantation, aortic valve regurgitation had a small, but discernible, clinical effect, with some patients developing severe aortic valve regurgitation and requiring aortic valve procedures. These data have implications for the long-term management of left ventricular assist device recipients, in particular as the durability of implantable continuous flow left ventricular assist device therapy improves.
主动脉瓣反流会降低左心室辅助装置的机械效率。有证据表明，左心室辅助装置的植入会引发或加重主动脉瓣反流。然而，这并没有与非手术终末期心力衰竭患者的主动脉瓣反流进展进行比较。此外，其临床效果尚不清楚。我们旨在描述左心室辅助装置接受者中主动脉瓣反流的发展和进展，并确定其临床效果。
对 2004 年 1 月至 2011 年 1 月在杜克大学医学中心接受内置式左心室辅助装置的所有连续患者进行了回顾。排除先前或同时进行主动脉瓣手术的病例。对其余植入物（n=184）和同期非手术终末期心力衰竭患者（n=132）的对照组数据进行了分析。连续经胸超声心动图用于随时间推移描述主动脉瓣反流。
与非手术终末期心力衰竭患者相比（P<.0001），左心室辅助装置植入后主动脉瓣反流恶化，定义为主动脉瓣反流程度增加。与脉冲式左心室辅助装置相比，连续流左心室辅助装置的接受者更有可能发生主动脉瓣反流恶化（P=.0348）。21 例左心室辅助装置接受者发生中度或重度主动脉瓣反流；这与植入的装置类型（连续式与脉冲式；P=.754）或左心室辅助装置植入前的主动脉瓣反流程度（P=.42）无关。5 例患者发生严重主动脉瓣反流；所有患者均进行了主动脉瓣手术。
在左心室辅助装置植入后，自身主动脉瓣反流发展和/或进展，在连续流左心室辅助装置接受者中更为明显。然而，术前主动脉瓣反流程度与左心室辅助装置植入后发生大量主动脉瓣反流无关。左心室辅助装置植入后，主动脉瓣反流有轻微但可识别的临床效果，一些患者发生严重主动脉瓣反流并需要进行主动脉瓣手术。这些数据对左心室辅助装置接受者的长期管理具有重要意义，尤其是随着可植入连续流左心室辅助装置治疗的耐久性提高。
