Fukuhara Shinichi, Takeda Koji, Chiuzan Codruta, Han Jiho, Polanco Antonio R, Yuzefpolskaya Melana, Mancini Donna M, Colombo Paolo C, Topkara Veli K, Kurlansky Paul A, Takayama Hiroo, Naka Yoshifumi
Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY.
Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY.
J Thorac Cardiovasc Surg. 2016 Jan;151(1):201-9, 210.e1-2. doi: 10.1016/j.jtcvs.2015.09.128. Epub 2015 Oct 19.
Aortic insufficiency (AI) after continuous-flow left ventricular assist device implantation can affect patient outcomes. Central aortic valve closure (CAVC) is a strategy commonly practiced; however, its efficacy has not been extensively investigated.
From March 2004 to May 2014, a total of 340 patients received a continuous-flow left ventricular assist device (89; 26.2%) as destination therapy (DT). Outcomes were compared between patients with CAVC (n = 57 [16.8%]; group A) versus without repair (n = 283 [83.2%]; group B).
Patients in group A were older, were more likely to be having DT, had a greater cardiopulmonary bypass and aortic crossclamp time, and more often received intraoperative transfusions than did patients in group B. Twenty-three (40.4%) patients in group A had significant pre-existing AI, defined as >mild AI, whereas none did in group B. Kaplan-Meier analysis revealed that freedom from significant AI was 66.7% and 59.9% at 2 years (P = .77) in groups A and B, respectively. In the DT cohort, freedom from significant AI was 78.1% and 41.8% at 2 years (P = .077). A generalized mixed-effects model demonstrated a 57% and 69% decrease in the odds of significant AI progression among repaired patients in the entire and DT cohort, respectively, after adjusting for time effect and degree of baseline pre-existing AI.
Despite pre-existing AI, the prevalence of significant AI in patients with CAVC was comparable to the AI in those without pre-existing AI/CAVC. The efficacy of this technique was more evident in DT patients. Thus, CAVC may be an effective and durable strategy, especially in patients who require lengthy device support.
连续流左心室辅助装置植入术后的主动脉瓣关闭不全（AI）会影响患者预后。中心主动脉瓣关闭（CAVC）是一种常用策略；然而，其疗效尚未得到广泛研究。
2004年3月至2014年5月，共有340例患者接受了连续流左心室辅助装置作为终末期治疗（DT）（89例；26.2%）。比较了接受CAVC的患者（n = 57 [16.8%]；A组）和未进行修复的患者（n = 283 [83.2%]；B组）的预后。
A组患者年龄更大，更有可能接受DT，体外循环和主动脉阻断时间更长，术中输血频率也高于B组患者。A组中有23例（40.4%）患者术前存在严重AI，定义为>轻度AI，而B组中无一例。Kaplan-Meier分析显示，A组和B组在2年时无严重AI的生存率分别为66.7%和59.9%（P = 0.77）。在DT队列中，2年时无严重AI的生存率分别为78.1%和41.8%（P = 0.077）。一个广义混合效应模型显示，在调整时间效应和基线术前AI程度后，整个队列和DT队列中接受修复的患者发生严重AI进展的几率分别降低了57%和69%。
尽管存在术前AI，但CAVC患者中严重AI的患病率与无术前AI/CAVC患者中的AI患病率相当。该技术的疗效在DT患者中更为明显。因此，CAVC可能是一种有效且持久的策略，尤其是在需要长期装置支持的患者中。
