Cordtz Joakim, Nilsson Jens C, Hansen Peter B, Sander Kaare, Olesen Peter S, Boesgaard Søren, Gustafsson Finn
Department of Cardiothoracic Anesthesiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Eur J Cardiothorac Surg. 2014 May;45(5):847-53. doi: 10.1093/ejcts/ezt519. Epub 2013 Nov 19.
Right ventricular failure (RVF) is a significant complication after implantation of a left ventricular assist device. We aimed to identify haemodynamic changes in the early postoperative phase that predicted subsequent development of RVF in a cohort of HeartMate II (HMII) implanted patients.
This was a single-centre observational study of consecutive placement of HMII devices at Rigshospitalet, Copenhagen. Preoperative data (right heart catheterization, biochemistry and clinical status) and postoperative readings from the first 72 h after implantation (haemodynamics, inotropic and vasoactive therapy) were included in the analysis. The data set was examined for significant differences between patients who developed RVF (RVF group, n = 11)-defined as need for inotropic or vasodilator therapy >14 days, nitric oxide therapy ≥ 48 h or right ventricular assist device therapy-and those who did not (non-RVF group, n = 22).
Preoperative right heart catheterization data were similar in the two groups. Immediately after HMII implantation, the increase in cardiac index (CI) was significantly larger in the non-RVF than in the RVF group (0.96 ± 0.8 vs 0.2 ± 0.5 L/min, respectively; P = 0.018), whereas right ventricular stroke work index (RVSWI) decreased significantly more in the RVF group (-4.3 ± 2.0 vs -0.9 ± 2.0 g m/m(2); P < 0.001). These differences were present in spite of the RVF group receiving larger doses of catecholaminergic agents (P = 0.034). Over the ensuing 72 h, the CI of the RVF group gradually approached that of the non-RVF group; concurrently, however, the differences in inotropic therapy were further enhanced. Pump settings were similar in the two groups.
The haemodynamic alterations characterizing RVF were present already immediately after HMII implantation. RVF development was not related to pump flow and settings.
右心室衰竭（RVF）是左心室辅助装置植入术后的一个重要并发症。我们旨在确定在一组植入HeartMate II（HMII）的患者中，术后早期可预测RVF后续发生的血流动力学变化。
这是一项在哥本哈根 Rigshospitalet 对连续植入 HMII 装置进行的单中心观察性研究。分析纳入了术前数据（右心导管检查、生化指标和临床状况）以及植入后最初72小时的术后读数（血流动力学、正性肌力和血管活性治疗）。对数据集进行检查，以找出发生 RVF 的患者（RVF 组，n = 11，定义为需要使用正性肌力或血管扩张剂治疗>14天、一氧化氮治疗≥48小时或右心室辅助装置治疗）与未发生 RVF 的患者（非 RVF 组，n = 22）之间的显著差异。
两组术前右心导管检查数据相似。HMII 植入后即刻，非 RVF 组的心指数（CI）升高显著大于 RVF 组（分别为0.96±0.8与0.2±0.5 L/min；P = 0.018），而 RVF 组的右心室每搏功指数（RVSWI）下降显著更多（-4.3±2.0与-0.9±2.0 g m/m²；P < 0.001）。尽管 RVF 组接受了更大剂量的儿茶酚胺能药物，但这些差异仍然存在（P = 0.034）。在随后的72小时内，RVF 组的 CI 逐渐接近非 RVF 组；然而，与此同时，正性肌力治疗的差异进一步加大。两组的泵设置相似。
HMII 植入后即刻就已出现表征 RVF 的血流动力学改变。RVF 的发生与泵流量和设置无关。
