Saito Shunsuke, Toda Koichi, Miyagawa Shigeru, Yoshikawa Yasushi, Fukushima Satsuki, Sakata Yasushi, Mizote Isamu, Daimon Takashi, Sawa Yoshiki
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan,
J Artif Organs. 2015 Mar;18(1):27-34. doi: 10.1007/s10047-014-0802-0. Epub 2014 Nov 5.
Myocardial recovery occurs in a small cohort of patients receiving left ventricular assist device (LVAD) support, but identification of candidates for device removal remains challenging. We hypothesized that hemodynamic evaluation using echocardiography and right heart catheter during temporary suspension of LVAD support (LVAD-off test) can assess cardiac recovery to predict successful device removal. To prove this hypothesis, we reviewed 44 patients who underwent LVAD-off test from January 2000 to March 2011 at Osaka University Hospital. Twenty-two of them underwent LVAD explant, 9 showed sustaining recovery (successful explant, SE-group); whereas 13 had a recurrent heart failure (failed explant, FE-group). The other 22 patients remained LVAD dependent (nonrecovery, NR-group). Echocardiography showed significant lower ejection fraction (LVEF) in NR-group than in SE- and FE-group after termination of LVAD support, but there was no difference between SE- and FE-group. On the other hand, elevation in pulmonary capillary wedge pressure (ΔPCWP) was significantly smaller in SE-group than in FE- and NR-groups. The degree of cardiac fibrosis significantly increased in FE- and NR-group during the LVAD support, while it did not increase in SE-group. The degree of cardiac fibrosis at the time of LVAD explantation correlated significantly with PCWP at LVAD halt and ΔPCWP, and it had significant impact on the outcome after LVAD weaning. In conclusion, the data obtained during LVAD-off test using echocardiography and right heart catheter significantly correlated with the degree of cardiac fibrosis at the time of LVAD explantation. LVAD-off test is a useful method to predict the successful LVAD explantation.
一小部分接受左心室辅助装置（LVAD）支持的患者会出现心肌恢复，但确定能够移除该装置的患者仍然具有挑战性。我们假设，在LVAD支持暂时中断期间（LVAD关闭试验）使用超声心动图和右心导管进行血流动力学评估，可以评估心脏恢复情况，以预测装置移除是否成功。为了验证这一假设，我们回顾了2000年1月至2011年3月在大阪大学医院接受LVAD关闭试验的44例患者。其中22例患者接受了LVAD植入物移除，9例显示持续恢复（成功移除植入物，SE组）；而13例出现了复发性心力衰竭（移除植入物失败，FE组）。另外22例患者仍然依赖LVAD（未恢复，NR组）。超声心动图显示，LVAD支持终止后，NR组的射血分数（LVEF）显著低于SE组和FE组，但SE组和FE组之间没有差异。另一方面，SE组肺毛细血管楔压升高（ΔPCWP）明显小于FE组和NR组。在LVAD支持期间，FE组和NR组的心脏纤维化程度显著增加，而SE组没有增加。LVAD植入时的心脏纤维化程度与LVAD停止时的PCWP和ΔPCWP显著相关，并且对LVAD撤机后的结果有显著影响。总之，在LVAD关闭试验期间使用超声心动图和右心导管获得的数据与LVAD植入时的心脏纤维化程度显著相关。LVAD关闭试验是预测LVAD成功植入的一种有用方法。
