左心室辅助装置植入术后右心衰竭的预测因素及管理
Predictors and management of right heart failure after left ventricular assist device implantation.
作者信息
Fida Nadia, Loebe Matthias, Estep Jerry D, Guha Ashrith
机构信息
Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
出版信息
Methodist Debakey Cardiovasc J. 2015 Jan-Mar;11(1):18-23. doi: 10.14797/mdcj-11-1-18.
Abstract
Newer generation continuous-flow left ventricular assist devices (LVADs) have overall improved outcomes with lower incidences of right ventricular failure (RVF) than their pulsatile predecessors, yet RVF still occurs in 9% to 40% of LVAD recipients. Post-implant, RVF is associated with poor outcomes, end-organ dysfunction, high mortality, and reduced survival to transplant. Therefore, preoperative risk stratification, appropriate patient selection, and optimal timing of implant are of paramount importance. In this article, we review the definition, incidence, pathophysiology, and current risk prediction models for RVF and touch on the contemporary management of RVF perioperatively and post-LVAD implant.
摘要
新一代连续血流左心室辅助装置（LVAD）总体上改善了治疗效果，与搏动性前代装置相比，右心室衰竭（RVF）的发生率更低，但仍有9%至40%的LVAD植入患者会发生RVF。植入后，RVF与不良预后、终末器官功能障碍、高死亡率以及移植生存率降低相关。因此，术前风险分层、合适的患者选择以及最佳植入时机至关重要。在本文中，我们回顾了RVF的定义、发生率、病理生理学以及当前的风险预测模型，并探讨了LVAD植入围手术期及术后RVF的当代管理方法。
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