Welp Henryk, Sindermann Jürgen R, Deschka Heinz, Martens Sven, Scherer Mirela
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University Hospital Münster, Münster, Germany.
J Cardiothorac Vasc Anesth. 2016 Jun;30(3):627-31. doi: 10.1053/j.jvca.2015.07.012. Epub 2015 Jul 14.
Right heart failure still occurs in up to 20% of patients after implantation of a left ventricular assist device (LVAD). One treatment option for these patients is the implantation of a temporary right ventricular assist device (RVAD). Experimental data suggest that non-pulsatile perfusion of the lungs is associated with an increased rate of pulmonary hemorrhage. The aim of this study was to determine the incidence of pulmonary bleeding complications in these patients.
Observational study.
Single center, university hospital.
This study included patients undergoing LVAD implantation for end-stage heart failure and subsequent implantation of a temporary right ventricular support system.
In this study, 25 patients who underwent LVAD and additional temporary RVAD implantation were screened for pulmonary bleeding complications.
The mean Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level at the time of LVAD implantation was 2.84. All patients experienced severe right ventricular failure (tricuspid annular plane systolic excursion [TAPSE], 10.16±26.3 mm) and severe pulmonary hypertension (right atrial [RA] pressure, 56.21±15.58 mmHg). Average duration of right ventricular support was 11.12±7.20 days, with right ventricular support being administered to 14 patients for more than 7 days. Seventeen patients were weaned successfully from right ventricular support after a mean support duration of 5 days. Five patients developed pulmonary bleeding complications, diagnosed using computed tomography scan and bronchoscopy. All bleeding occurred after postoperative day 7 and was associated with RVAD flow of more than 4 L/min within 24 hours before bleeding occurred.
The data presented in this study suggested that right ventricular support for more than 7 days and a blood flow greater than 4 L/min were associated with pulmonary bleeding complications. This should be taken into consideration when temporary right ventricular support after LVAD implantation is planned.
在植入左心室辅助装置（LVAD）后，仍有高达20%的患者会发生右心衰竭。对于这些患者，一种治疗选择是植入临时右心室辅助装置（RVAD）。实验数据表明，肺部的非搏动性灌注与肺出血发生率增加有关。本研究的目的是确定这些患者肺出血并发症的发生率。
观察性研究。
单中心大学医院。
本研究纳入了因终末期心力衰竭接受LVAD植入并随后植入临时右心室支持系统的患者。
在本研究中，对25例接受LVAD植入及额外临时RVAD植入的患者进行了肺出血并发症筛查。
LVAD植入时的平均机械辅助循环支持机构间注册（INTERMACS）分级为2.84。所有患者均出现严重右心衰竭（三尖瓣环平面收缩期位移[TAPSE]，10.16±26.3mm）和严重肺动脉高压（右心房[RA]压力，56.21±15.58mmHg）。右心室支持的平均持续时间为11.12±7.20天，14例患者接受右心室支持超过7天。17例患者在平均支持5天后成功撤掉右心室支持。5例患者发生肺出血并发症，通过计算机断层扫描和支气管镜检查确诊。所有出血均发生在术后第7天之后，且与出血发生前24小时内RVAD流量超过4L/min有关。
本研究呈现的数据表明，右心室支持超过7天以及血流量大于4L/min与肺出血并发症有关。在计划LVAD植入后的临时右心室支持时应考虑到这一点。
