Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Artificial Heart Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ann Thorac Surg. 2014 Jan;97(1):139-46. doi: 10.1016/j.athoracsur.2013.07.069. Epub 2013 Sep 25.
Continuous flow (CF) left ventricular assist devices (LVAD) are afterload sensitive and therefore pump performance is affected by hypertension. In addition, poorly controlled hypertension may increase the risk of aortic insufficiency (AI) and stroke. Blood pressure regimens after CF LVAD have not been studied and their impact on rates of AI and stroke are unknown.
Patients who had CF LVAD at a single center and were supported greater than 30 days were included. Blood pressure was monitored at home by Doppler. Outpatient management of blood pressure was conducted according to a predefined institutional protocol (target mean arterial pressure ≤ 80 mm Hg).
A total of 96 patients were included. At the end of follow-up, 25 patients were not on an antihypertensive drug, of these 9 died. Of the 74% receiving antihypertensives, 54% required 1 medication, 34% were on 2, 10% were on 3, and 3% were on 4 or more. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (85% of patients on an antihypertensive) and beta blockers (30%) were the most commonly prescribed medications. There was a significantly higher neurologic event rate in those on no antihypertensives compared with those on antihypertensives (p = 0.009). Only 3% of patients with no or mild AI at baseline progressed to develop moderate or greater AI after a mean of 201 days of follow-up.
Blood pressure control can be achieved in patients with CF LVADs, with the majority of patients requiring only 1 or 2 antihypertensives.
连续流（CF）左心室辅助装置（LVAD）是后负荷敏感的，因此泵的性能受高血压的影响。此外，高血压控制不佳可能会增加主动脉瓣关闭不全（AI）和中风的风险。CF LVAD 后的血压方案尚未得到研究，其对 AI 和中风发生率的影响尚不清楚。
本研究纳入了在单中心接受 CF LVAD 并支持时间大于 30 天的患者。在家中通过多普勒监测血压。根据预先设定的机构方案（目标平均动脉压≤80mmHg）对门诊血压进行管理。
共纳入 96 例患者。在随访结束时，25 例患者未服用降压药，其中 9 例死亡。在接受降压治疗的 74%的患者中，54%需要服用 1 种药物，34%需要服用 2 种，10%需要服用 3 种，3%需要服用 4 种或更多种。血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂（接受降压治疗患者的 85%）和β受体阻滞剂（30%）是最常用的药物。与服用降压药的患者相比，未服用降压药的患者神经事件发生率明显更高（p=0.009）。在平均随访 201 天后，仅有 3%的基线时无或轻度 AI 的患者进展为中重度 AI。
CF LVAD 患者的血压控制可以实现，大多数患者仅需服用 1 种或 2 种降压药。
