Cowger Jennifer A, Aaronson Keith D, Romano Matthew A, Haft Jonathan, Pagani Francis D
Mechanical Circulatory Support and Transplant Program, St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
University of Michigan Cardiovascular Center, Ann Arbor, Michigan.
J Heart Lung Transplant. 2014 Dec;33(12):1233-40. doi: 10.1016/j.healun.2014.06.008. Epub 2014 Jun 23.
Although left ventricular assist device (LVAD) management strategies are undertaken to reduce the development of aortic insufficiency (AI), the effect of AI on patient morbidity and mortality is not known.
Patients undergoing HeartMate II (Thoratec, Pleasanton, CA) implant were prospectively monitored with serial echocardiograms. Kaplan-Meier methods and log-rank testing were used to estimate and compare mortality and freedom from moderate or worser right ventricular hypokinesis (RVHK), moderate or worse mitral regurgitation (MR), and hemolysis according to AI severity. Mixed modelling was used to examine for correlates of AI development in the pre-operative and post-operative setting and to investigate the effect of AI on post-operative MR and RVHK.
There were 930 echocardiograms completed in 166 patients. During 291 person-years of follow-up, mild-moderate or worse AI developed in 70 (0.38 persons per year [PPY]), moderate or worse AI in 36 (0.17 PPY), moderate-severe AI in 11 (0.039 PPY), and severe AI in 2 (0.0069 PPY). Overall 2-year survival and 2-year survival after onset of moderate or worse AI was 87% ± 6.2% and 65% ± 11%, respectively, compared with 76% ± 5.1% and 76% ± 5.1%, respectively, in those with less AI (p = 0.57). Patients with moderate AI were not more likely to develop MR, hemolysis events, or worsening RVHK, but patients with pre-existing RVHK appeared to be less tolerant of AI. Three of 35 deaths were directly attributed to AI. No reoperations were performed solely for AI.
AI is common after LVAD implant but did not affect survival in this cohort. Except in those with significant RV dysfunction, this calls into question need for echocardiogram-guided device settings to ensure aortic valve opening.
尽管采取左心室辅助装置（LVAD）管理策略以减少主动脉瓣关闭不全（AI）的发生，但AI对患者发病率和死亡率的影响尚不清楚。
对接受HeartMate II（Thoratec，普莱森顿，加利福尼亚州）植入的患者进行前瞻性连续超声心动图监测。采用Kaplan-Meier方法和对数秩检验，根据AI严重程度估计和比较死亡率以及无中度或更严重右心室运动减弱（RVHK）、中度或更严重二尖瓣反流（MR）和溶血的情况。使用混合模型检查术前和术后AI发生的相关因素，并研究AI对术后MR和RVHK的影响。
166例患者共完成930次超声心动图检查。在291人年的随访期间，70例（每年0.38人[PPY]）出现轻中度或更严重AI，36例（0.17 PPY）出现中度或更严重AI，11例（0.039 PPY）出现中重度AI，2例（0.0069 PPY）出现重度AI。总体而言，中度或更严重AI发生后2年生存率和2年生存率分别为87%±6.2%和65%±11%，而AI较轻者分别为76%±5.1%和76%±5.1%（p = 0.57）。中度AI患者发生MR、溶血事件或RVHK恶化的可能性并不更高，但已有RVHK的患者似乎对AI的耐受性较差。35例死亡中有3例直接归因于AI。没有仅因AI而进行再次手术。
LVAD植入后AI很常见，但在该队列中不影响生存。除了那些有明显右心室功能障碍的患者外，这使人质疑是否需要超声心动图引导的装置设置来确保主动脉瓣开放。
