连续流左心室辅助装置治疗终末期心力衰竭患者血流动力学的正常化
Normalisation of haemodynamics in patients with end-stage heart failure with continuous-flow left ventricular assist device therapy.
作者信息
Gupta Sunil, Woldendorp Kei, Muthiah Kavitha, Robson Desiree, Prichard Roslyn, Macdonald Peter S, Keogh Anne M, Kotlyar Eugene, Jabbour Andrew, Dhital Kumud, Granger Emily, Spratt Phillip, Jansz Paul, Hayward Christopher S
机构信息
Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia.
Heart Failure and Transplant Unit, St. Vincent's Hospital, Sydney, Australia; Faculty of Medicine, The University of New South Wales, Sydney, Australia; Faculty of Medicine, Victor Chang Cardiac Research Institute, Sydney, Australia.
出版信息
Heart Lung Circ. 2014 Oct;23(10):963-9. doi: 10.1016/j.hlc.2014.04.259. Epub 2014 Jun 3.
BACKGROUND
New generation continuous-flow left ventricular assist devices (LVADs) utilise centrifugal pumps. Data concerning their effect on patient haemodynamics, ventricular function and tissue perfusion is limited. We aimed to document these parameters following HeartWare centrifugal continuous-flow LVAD (HVAD) implantation and to assess the impact of post-operative right heart failure (RHF).
METHODS
We reviewed 53 consecutive patients (mean age 49.5 ± 14.1 yrs) with HVAD implanted in the left ventricle, at St. Vincent's Hospital, Sydney, between January 2007 and August 2012. Available paired right heart catheterisation (n=35) and echocardiography (n=39) data was reviewed to assess response of invasive haemodynamics and ventricular function to LVAD support.
RESULTS
A total of 28 patients (53%) were implanted from interim mechanical circulatory support. Seventeen patients (32%) required short-term post-implant veno-pulmonary artery extracorporeal membrane oxygenation. At 100 ± 61 days post-implant, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased from 38.8 ± 7.7 to 22.9 ± 7.7 mmHg and 28.3 ± 6.4 to 13.4 ± 5.4 mmHg respectively (p<0.001). LV end diastolic diameter decreased from 71.3 ± 12.7 to 61.1 ± 13.7 mm and LV end-systolic diameter from 62.7 ± 12.3 to 53.9 ± 14.4mm (p<0.001). Aortic regurgitation remained trivial. Serum sodium increased from 133.3 ± 5.7 to 139.3 ± 2.8 mmol/L and creatinine decreased from 109.1 ± 42.5 to 74.3 ± 26.2 μmol/L (p<0.001). Across the entire cohort, the six-month survival/transplant rate was significantly lower for RHF patients (72.2%, n=18) compared to those without (96.9%, n=35, p=0.01).
CONCLUSIONS
HVAD support improves haemodynamics, LV dimensions and renal function. Following implantation with a centrifugal continuous-flow LVAD, RHF remains a significant risk with a tendency to worse outcomes in the short to medium term.
背景
新一代连续流左心室辅助装置（LVAD）采用离心泵。关于其对患者血流动力学、心室功能和组织灌注影响的数据有限。我们旨在记录植入HeartWare离心式连续流LVAD（HVAD）后的这些参数，并评估术后右心衰竭（RHF）的影响。
方法
我们回顾了2007年1月至2012年8月期间在悉尼圣文森特医院连续植入左心室HVAD的53例患者（平均年龄49.5±14.1岁）。回顾可用的配对右心导管检查（n=35）和超声心动图（n=39）数据，以评估有创血流动力学和心室功能对LVAD支持的反应。
结果
共有28例患者（53%）从临时机械循环支持植入。17例患者（32%）术后需要短期静脉-肺动脉体外膜肺氧合。植入后100±61天，平均肺动脉压和平均肺毛细血管楔压分别从38.8±7.7降至22.9±7.7 mmHg，从28.3±6.4降至13.4±5.4 mmHg（p<0.001）。左心室舒张末期直径从71.3±12.7降至61.1±13.7 mm，左心室收缩末期直径从62.7±12.3降至53.9±14.4 mm（p<0.001）。主动脉瓣反流仍很轻微。血清钠从133.3±5.7升至139.3±2.8 mmol/L，肌酐从109.1±42.5降至74.3±26.2 μmol/L（p<0.001）。在整个队列中，RHF患者（72.2%，n=18）的6个月生存率/移植率显著低于无RHF患者（96.9%，n=35，p=0.01）。
结论
HVAD支持可改善血流动力学、左心室大小和肾功能。植入离心式连续流LVAD后，RHF仍然是一个重大风险，在短期至中期有预后较差的趋势。
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