Bernhardt Alexander M, De By Theo M M H, Reichenspurner Hermann, Deuse Tobias
Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany
EUROMACS-European Registry for Patients with Mechanical Circulatory Support, Berlin, Germany.
Eur J Cardiothorac Surg. 2015 Jul;48(1):158-62. doi: 10.1093/ejcts/ezu406. Epub 2014 Oct 29.
Isolated right ventricular (RV) dysfunction with preserved left ventricular function is difficult to treat and associated with high mortality. Temporary devices for right ventricular support [right ventricular assist device (RVAD)] are available and have been used for short-term right heart assistance. In some patients, RV function does not recover and long-term devices are needed. Recently, isolated RVAD implantation with a permanent HeartWare HeartWare ventricular assist device (HVAD) device has been reported in patients with acute RV infarction and chronic graft failure. However, isolated implantation on the right side remains rare and is still an off-label use for this pump. To gather European data, we queried the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) database, in which procedures and outcome data for patients receiving mechanical circulatory support are registered.
Until May 2014, data of 8 patients (mean age 55.0 ± 17.3 years, 100% males) with an isolated HVAD for RV support were submitted to the EUROMACS registry. All patients were in INTERMACS classes 1-3. Device strategy was rescue therapy in 6 patients (75.0%) and destination therapy in 2 patients (25.0%). Indications for RVAD placement were acute myocardial infarction in 4 (50.0%), failure to wean from cardiopulmonary bypass in 2 (25.0%) and post-cardiotomy RV failure in another 2 patients (25.0%). Intra- and postoperative results of the EUROMACS registry were analysed.
Inflow cannulas were implanted into the right atrium (RA) in 6 patients (75.0%) and into the RV in 2 patients (25.0%). CPB was used in 6 patients (75.0%). Four patients (50.0%) survived the first 30 days. During follow-up, 1 patient died after 44 days due to multiorgan failure. In the surviving three patients, 2 patients were transplanted after 29 and 419 days, respectively, and, in 1 patient, the device was explanted for pump thrombosis and recovered RV function.
In this very specific and sick patient cohort within the EUROMACS registry, isolated permanent RVAD implantation is a novel and promising strategy for patients with isolated right heart failure. However, more experience is needed to identify patients who benefit from this technology.
左心室功能正常但孤立性右心室功能障碍难以治疗且死亡率高。右心室支持的临时装置[右心室辅助装置（RVAD）]已可获得并用于短期右心辅助。在一些患者中，右心室功能无法恢复，需要长期装置。最近，已有报道在急性右心室梗死和慢性移植物衰竭患者中植入永久性HeartWare心室辅助装置（HVAD）进行孤立性右心室辅助装置植入。然而，右侧孤立植入仍然少见，且该泵仍属超说明书使用。为收集欧洲数据，我们查询了欧洲机械循环支持患者注册数据库（EUROMACS），其中登记了接受机械循环支持患者的手术及结局数据。
截至2014年5月，8例（平均年龄55.0±17.3岁，均为男性）接受孤立性HVAD右心室支持患者的数据被提交至EUROMACS注册数据库。所有患者均处于INTERMACS 1 - 3级。6例患者（75.0%）的装置策略为挽救治疗，2例患者（25.0%）为目标治疗。右心室辅助装置置入的指征为急性心肌梗死4例（50.0%）、体外循环脱机失败2例（25.0%）和心脏术后右心室衰竭2例（25.0%）。分析了EUROMACS注册数据库的术中及术后结果。
6例患者（75.0%）将流入插管植入右心房（RA），2例患者（25.0%）植入右心室。6例患者（75.0%）使用了体外循环。4例患者（50.0%）存活至术后30天。随访期间，1例患者在44天后因多器官衰竭死亡。在存活的3例患者中，2例分别在29天和419天后接受了移植，1例患者因泵血栓形成取出装置，右心室功能恢复。
在EUROMACS注册数据库中这个非常特殊且病情严重的患者队列中，孤立性永久性右心室辅助装置植入对于孤立性右心衰竭患者是一种新颖且有前景的策略。然而，需要更多经验来确定能从该技术中获益的患者。
