Department of Cardiothoracic Surgery, St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
Research and Scientific Affairs, Thoratec Corporation, Pleasanton, California.
J Heart Lung Transplant. 2014 Aug;33(8):809-15. doi: 10.1016/j.healun.2014.02.024. Epub 2014 Feb 26.
The aim of this study was to evaluate the prevalence of early pump power elevation events in patients with the HeartMate II (HMII) and its impact on subsequent development of stroke and pump thrombosis.
We analyzed >45,000 measurements of pump power and pump speed measured during the initial hospitalization period and >12,000 follow-up measurements obtained from 138 consecutive patients implanted with a HMII between January 2009 and December 2012. An early power elevation (PEL) event was defined as power ≥10 W within the first 14 post-operative days. Patients were divided into two groups: those with an early PEL event and those without (NP).
Median follow-up duration was 316 (range 2 to 1,264) days. Twenty-seven (20%) patients had early PEL events that lasted for a total duration of 4 (range 1 to 77) hours per patient. Pump speed averaged 9,400 rpm in both groups. Although patients in the PEL group had higher median power (7.1 [6.0 to 9.9] W vs 6.7 [5.7 to 7.8] W, p < 0.001) in the immediate post-operative period, there was no difference between the two groups noted at first follow-up (6.6 [5.9 to 8.7] W vs 6.7 [5.5 to 7.7] W, p = 0.940). No differences in the prevalence of hemorrhagic stroke (4% vs 3%, p = 0.56), ischemic stroke (0% vs 4%, p = 0.41), hemolysis (7% vs 5%, p = 0.32), pump thrombosis (7% vs 4%, p = 0.21) or survival (76% at 1 year in both groups) were found between the two groups.
In this single-center experience, PEL events that occurred early all resolved by discharge. No relationship was found between early PEL events and subsequent development of pump thrombosis, hemorrhagic stroke or ischemic stroke.
本研究旨在评估 HeartMate II（HMII）患者早期泵功率升高事件的发生率及其对随后发生卒中与泵血栓形成的影响。
我们分析了 2009 年 1 月至 2012 年 12 月期间连续 138 例植入 HMII 的患者在住院期间的超过 45000 次泵功率和泵速测量值以及超过 12000 次随访测量值。早期功率升高（PEL）事件定义为术后 14 天内功率≥10W。患者分为两组：早期 PEL 事件组和无早期 PEL 事件组（NP）。
中位随访时间为 316（2-1264）天。27 例（20%）患者发生早期 PEL 事件，每位患者的总持续时间为 4（1-77）小时。两组患者的平均泵速均为 9400rpm。尽管 PEL 组患者在术后即刻的中位功率更高（7.1[6.0-9.9]W 比 6.7[5.7-7.8]W，p<0.001），但在首次随访时两组间无差异（6.6[5.9-8.7]W 比 6.7[5.5-7.7]W，p=0.940）。两组患者的出血性卒中发生率（4%比 3%，p=0.56）、缺血性卒中发生率（0%比 4%，p=0.41）、溶血发生率（7%比 5%，p=0.32）、泵血栓形成发生率（7%比 4%，p=0.21）或生存率（两组患者 1 年时生存率均为 76%）均无差异。
在本单中心经验中，早期发生的 PEL 事件均在出院前得到解决。早期 PEL 事件与随后发生的泵血栓形成、出血性卒中或缺血性卒中之间未发现关联。
