Leidenfrost Jeremy, Prasad Sunil, Itoh Akinobu, Lawrance Christopher P, Bell Jennifer M, Silvestry Scott C
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, MO, USA
Eur J Cardiothorac Surg. 2016 Jan;49(1):73-7. doi: 10.1093/ejcts/ezv116. Epub 2015 Apr 15.
Cardiogenic shock from refractory right ventricular (RV) failure during left ventricular assist device placement is associated with high morbidity and mortality. The addition of extracorporeal membrane oxygenation to RV mechanical assistance may help RV recovery and lead to improved outcomes.
We retrospectively reviewed all implanted continuous-flow left ventricular assist devices from April 2009 to June 2013. RV mechanical support was utilized for RV failure defined as haemodynamic instability despite vasopressors, pulmonary vascular dilators and inotropic therapy. RV assist devices were utilized with and without in-line membrane oxygenation.
During the study period, 267 continuous-flow left ventricular assist devices were implanted. RV mechanical support was utilized in 27 (10%) patients; 12 (46%) had the addition of in-line extracorporeal membrane oxygenation. The mean age of patients with a right ventricular assist device with membrane oxygenation was lower than that in patients with a right ventricular assist device alone (45.6 ± 15.9 vs 64.6 ± 6.5, P = 0.001). Support was weaned in 66% (10 of 15) of patients with right ventricular assist device (RVAD) alone vs 83% (10 of 12) of those with RVAD with membrane oxygenation (P = 0.42). The RVAD was removed after 10.4 ± 9.4 vs 5 ± 2.99 days for patients with a RVAD with membrane oxygenation (P = 0.1). Patients with RVAD with membrane oxygenation had a 30-day mortality rate of 8 vs 47% for those with RVAD alone (P = 0.04). The survival rate after discharge was 86, 63 and 54% at 3, 6 and 12 months for both groups combined.
Patients with a RVAD with membrane oxygenation support for acute RV failure after continuous-flow left ventricular assist device implantation had a lower 30-day mortality than those with a RVAD alone. Patients who survive to discharge have a reasonable 1-year survival. Combining membrane oxygenation with RVAD support appears to offer a short-term survival benefit in patients with RV failure after continuous-flow left ventricular assist device implantation.
在植入左心室辅助装置期间，难治性右心室（RV）衰竭所致的心源性休克与高发病率和死亡率相关。在右心室机械辅助基础上加用体外膜肺氧合可能有助于右心室恢复并改善预后。
我们回顾性分析了2009年4月至2013年6月期间所有植入的连续血流左心室辅助装置。右心室机械支持用于尽管使用了血管升压药、肺血管扩张剂和正性肌力药物治疗仍存在血流动力学不稳定的右心室衰竭患者。右心室辅助装置在联用或未联用在线膜肺氧合的情况下使用。
在研究期间，共植入267个连续血流左心室辅助装置。27例（10%）患者使用了右心室机械支持；其中12例（46%）联用了在线体外膜肺氧合。联用膜肺氧合的右心室辅助装置患者的平均年龄低于单纯使用右心室辅助装置的患者（45.6±15.9岁对64.6±6.5岁，P = 0.001）。单纯使用右心室辅助装置（RVAD）的患者中66%（15例中的10例）撤机，而联用膜肺氧合的RVAD患者中83%（12例中的10例）撤机（P = 0.42）。联用膜肺氧合的RVAD患者在10.4±9.4天后移除RVAD，而单纯RVAD患者在5±2.99天后移除（P = 0.1）。联用膜肺氧合的RVAD患者30天死亡率为8%，而单纯RVAD患者为47%（P = 0.04）。两组患者出院后3、6和12个月的生存率分别为86%、63%和54%。
连续血流左心室辅助装置植入后，联用膜肺氧合支持的急性右心室衰竭RVAD患者30天死亡率低于单纯RVAD患者。存活至出院的患者1年生存率合理。膜肺氧合与RVAD支持联合应用似乎为连续血流左心室辅助装置植入后右心室衰竭患者提供了短期生存获益。
