Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA.
J Heart Lung Transplant. 2013 Apr;32(4):398-403. doi: 10.1016/j.healun.2012.12.018. Epub 2013 Feb 9.
Continuous-flow (CF) pumps have yielded improvements in short- and long-term survival and quality of life, and have reduced the number of left ventricular assist device (LVAD)-related complications. However, their ability to unload the right ventricle (RV) and improve RV function has not been as clearly defined. We evaluated the short- and mid-term effects of CF-LVADs on central venous pressure (CVP), pulmonary artery pressures (PAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), RV ejection fraction (RVEF), RV end-diastolic dimension (RVEDD), RV stroke work index (RVSWI), tricuspid annular plane systolic excursion (TAPSE) and severity of tricuspid regurgitation (TR).
From March 2006 through June 2012, 130 patients with chronic heart failure underwent implantation of a CF-LVAD (122 HeartMate II and 8 HeartWare devices) as a bridge to transplant (n = 76) or as destination therapy (n = 54). Patients with pre-operative long-term LVADs (n = 4) and patients who underwent concomitant tricuspid valve repairs during their LVAD implant (n = 21) were excluded from the analysis. Echocardiograms and right heart catheterizations of the remaining 105 patients were reviewed pre-operatively and at 1 and 6 months post-LVAD implantation.
At 1 month post-LVAD implantation, CVP decreased from 12.4 ± 5.9 mm Hg to 8.7 ± 4.5 mm Hg (p < 0.001), systolic PAP decreased from 52.3 ± 14.1 mm Hg to 36.8 ± 11.3 mm Hg (p < 0.001), PCWP decreased from 23.0 ± 9.4 mm Hg to 12.9 ± 8.0 mm Hg (p < 0.001), CI index increased from 1.8 ± 0.5 liters/min m2 to 2.4 ± 0.5 liters/min m2 (p < 0.001), RVEF increased from 33.1 ± 4.9% to 40.4 ± 6.2% (p < 0.001), RVEDD decreased from 36 mm to 31 mm (p = 0.020), RVSWI improved from 408.6 ± 144.6 mm Hg ml m2 to 614.4 ± 196.2 mm Hg ml m2 (p < 0.001), and mean TAPSE increased from 1.1 ± 0.4 cm to 1.9 ± 0.4 cm (p = 0.004). Similarly, qualitative RV function on echocardiography improved from 57.1% moderately or severely reduced pre-operatively to 38.1% at 1 month (p = 0.008). Severity of TR decreased from 11.4% moderate or severe pre-operatively to 4.8% at 1 month (p < 0.001). These improvements were maintained at 6 months post-LVAD.
CF-LVAD support significantly decreased CVP and RVEDD, with concomitant improvement in RV function, as measured by increases in RVEF, RVSWI and TAPSE, as well as improvements in the qualitative echocardiographic appearance of RV contractility and a reduction in TR.
连续流（CF）泵在短期和长期生存率和生活质量方面都有改善，并减少了左心室辅助装置（LVAD）相关并发症的发生。然而，它们对右心室（RV）的卸载能力和改善 RV 功能的能力尚未得到明确界定。我们评估了 CF-LVAD 在中心静脉压（CVP）、肺动脉压（PAP）、肺毛细血管楔压（PCWP）、心指数（CI）、右心室射血分数（RVEF）、右心室舒张末期内径（RVEDD）、右心室每搏功指数（RVSWI）、三尖瓣环平面收缩位移（TAPSE）和三尖瓣反流（TR）严重程度方面的短期和中期效果。
从 2006 年 3 月至 2012 年 6 月，130 例慢性心力衰竭患者接受了 CF-LVAD（122 例 HeartMate II 和 8 例 HeartWare 装置）桥接移植（n=76）或作为终末期治疗（n=54）。排除术前长期使用 LVAD（n=4）和 LVAD 植入期间同时进行三尖瓣修复的患者（n=21）。对其余 105 例患者的超声心动图和右心导管检查结果进行了回顾性分析，包括术前和 LVAD 植入后 1 个月和 6 个月。
LVAD 植入后 1 个月，CVP 从 12.4±5.9mmHg 降至 8.7±4.5mmHg（p<0.001），收缩 PAP 从 52.3±14.1mmHg 降至 36.8±11.3mmHg（p<0.001），PCWP 从 23.0±9.4mmHg 降至 12.9±8.0mmHg（p<0.001），CI 指数从 1.8±0.5L/min/m2 增加到 2.4±0.5L/min/m2（p<0.001），RVEF 从 33.1±4.9%增加到 40.4±6.2%（p<0.001），RVEDD 从 36mm 减少到 31mm（p=0.020），RVSWI 从 408.6±144.6mmHg ml m2 增加到 614.4±196.2mmHg ml m2（p<0.001），平均 TAPSE 从 1.1±0.4cm 增加到 1.9±0.4cm（p=0.004）。同样，术前超声心动图中 RV 功能中度或重度降低的比例从 57.1%下降到 1 个月时的 38.1%（p=0.008）。TR 严重程度从术前的 11.4%中度或重度下降到 1 个月时的 4.8%（p<0.001）。这些改善在 LVAD 植入后 6 个月时得以维持。
CF-LVAD 支持显著降低了 CVP 和 RVEDD，同时改善了 RV 功能，表现为 RVEF、RVSWI 和 TAPSE 的增加，以及 RV 收缩力的超声心动图外观的改善和 TR 的减少。
