Division of Cardiac Surgery, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
J Heart Lung Transplant. 2014 Aug;33(8):794-9. doi: 10.1016/j.healun.2014.02.028. Epub 2014 Mar 4.
Acute right ventricular failure (ARVF) refractory to optimal medical management may require rescue therapy with mechanical circulatory support (MCS). The RV exhibits a greater capacity for rapid recovery than the left ventricle, making devices designed specifically for temporary RV MCS attractive. We report our experience with the Impella Right Direct (RD) and Right Peripheral (RP) temporary ventricular assist devices (Abiomed, Danvers, MA) in patients with ARVF.
We conducted a retrospective cohort study examining the clinical outcomes of consecutive patients supported with the Impella RD or RP at 2 institutions during a 6-year period.
During the study period, 18 patients (67% men; mean age 57 ± 10 years) received MCS, 15 with the Impella RD and 3 with the Impella RP. Before RV MCS, all patients required intravenous inotropes, 7 (39%) required inhaled nitric oxide, 7 (39%) required intra-aortic balloon counterpulsation, and 2 (11%) had experienced a cardiac arrest. Device implantation resulted in an improvement in cardiac index (2.1 ± 0.1 liters/min/m(2) pre-implant vs 2.6 ± 0.2 liters/min/m(2) post-implant, p = 0.04) and reduced central venous pressure (22 ± 5 vs 15 ± 4 mm Hg, p < 0.01). Fourteen (78%) patients recovered sufficient RV function to facilitate device explanation after 7 days (range, 2-19 days) of support, and 4 (22%) patients died on support after 6 days (range 1-11 days). Survival to 30 days was 72% and to 1 year was 50%. At 1-year follow-up, the mean New York Heart Association functional classification was 1.3 ± 0.5, and only 1 patient demonstrated severe RV dysfunction on echocardiography.
Most patients with ARVF rapidly recover sufficient RV function to facilitate device explantation, highlighting an expanding role for minimally invasive temporary RV assist devices optimized for the treatment of recoverable ARVF.
急性右心室衰竭（ARVF）对最佳药物治疗无反应时，可能需要机械循环支持（MCS）进行抢救治疗。与左心室相比，右心室具有更大的快速恢复能力，因此专门设计用于临时右心室 MCS 的设备具有吸引力。我们报告了在 2 家机构的 6 年期间，使用 Impella RD 和 RP 临时心室辅助装置（Abiomed，Danvers，MA）治疗 ARVF 患者的经验。
我们进行了一项回顾性队列研究，检查了在 6 年期间在 2 家机构接受 Impella RD 或 RP 支持的连续患者的临床结果。
在研究期间，18 名患者（67%为男性；平均年龄 57 ± 10 岁）接受了 MCS，15 名患者使用 Impella RD，3 名患者使用 Impella RP。在右心室 MCS 之前，所有患者均需要静脉内正性肌力药物，7 名（39%）需要吸入一氧化氮，7 名（39%）需要主动脉内球囊反搏，2 名（11%）发生了心脏骤停。装置植入后，心指数改善（植入前 2.1 ± 0.1 升/分钟/平方米，植入后 2.6 ± 0.2 升/分钟/平方米，p = 0.04），中心静脉压降低（22 ± 5 毫米汞柱 vs 15 ± 4 毫米汞柱，p < 0.01）。14 名（78%）患者在 7 天（2-19 天）的支持后恢复了足够的右心室功能以方便装置拔出，4 名（22%）患者在 6 天（1-11 天）的支持后死亡。30 天生存率为 72%，1 年生存率为 50%。1 年随访时，平均纽约心脏协会功能分级为 1.3 ± 0.5，仅 1 名患者在超声心动图上显示严重的右心室功能障碍。
大多数 ARVF 患者的右心室功能迅速恢复，足以方便装置拔出，这突显了微创临时右心室辅助装置在治疗可恢复性 ARVF 方面的作用不断扩大。
