Kazui Toshinobu, Zhang Andrew, Greenberg Jason, Itoh Akinobu, Tran Phat L, Keith Angela D, Ewald Greg A, Damiano Ralph J, Silvestry Scott C
Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri.
Ann Thorac Surg. 2016 Dec;102(6):1933-1940. doi: 10.1016/j.athoracsur.2016.05.025. Epub 2016 Jul 26.
This study investigates the impact of left ventricular assist device (LVAD) inflow cannula angulation, pump positional change over time, and the incidence of thrombotic pump dysfunction in a large cohort of HeartMate II (HM2) patients.
Patients (n = 326) who received primary HM2 LVAD between January 2008 and December 2013 at a single institution were retrospectively reviewed. Patients who underwent pump exchange (PE) for pump dysfunction, patients who had pump dysfunction (PD) but did not require pump exchange, and patients with normal LVAD pump dysfunction (NL) were compared. Pump positional change and angle of the inflow cannula with respect to the angle between inflow cannula and the LVAD body (IL angle) were measured from routine chest radiograph at postoperation, before discharge, and follow-up. Pump positional change was assessed based on pump positional differences between discharge and follow-up. Patients were also grouped by IL acute angulation (less than 65 degrees) and pump positional change.
There were 21, 15, and 290 patients in the PE group, PD group, and NL group, respectively. There were significant differences in IL angle between PE and NL at all timepoints: postoperation (PD 63.6 ± 12.5, NL 70.6 ± 12.3; p = 0.018), before discharge (PD 64.4 ± 12.8, NL 69.5 ± 10.5; p = 0.039), and follow-up (PD 62.6 ± 14.2, NL 67.9 ± 11.2; p = 0.002). However, the IL angle was insignificant between PE and PD groups and between PD and NL groups. Sixty-seven percent of the PE group had pump positional change as opposed to 36% of the NL group (p = 0.019). Eighty-four of 101 patients with pump positional change and 75 of 91 patients with acute angulation at postoperation did not have pump dysfunction.
Pump positional change may contribute to LVAD dysfunction or failure, but it does not entirely account for observed pump dysfunction or failure.
本研究调查了左心室辅助装置（LVAD）流入插管角度、泵随时间的位置变化以及大量HeartMate II（HM2）患者中血栓性泵功能障碍的发生率。
回顾性分析了2008年1月至2013年12月在单一机构接受原发性HM2 LVAD的患者（n = 326）。比较了因泵功能障碍接受泵置换（PE）的患者、有泵功能障碍（PD）但不需要泵置换的患者以及左心室辅助装置泵功能正常（NL）的患者。从术后、出院前和随访时的常规胸部X线片测量泵的位置变化以及流入插管相对于流入插管与LVAD主体之间角度（IL角）的角度。根据出院时和随访时的泵位置差异评估泵的位置变化。患者还按IL急性角度（小于65度）和泵位置变化进行分组。
PE组、PD组和NL组分别有21例、15例和290例患者。在所有时间点，PE组和NL组之间的IL角存在显著差异：术后（PD 63.6±12.5，NL 70.6±12.3；p = 0.018）、出院前（PD 64.4±12.8，NL 69.5±10.5；p = 0.039）和随访时（PD 62.6±14.2，NL 67.9±11.2；p = 0.002）。然而，PE组和PD组之间以及PD组和NL组之间的IL角无显著差异。PE组67%的患者有泵位置变化，而NL组为36%（p = 0.019）。101例有泵位置变化的患者中有84例以及术后91例有急性角度的患者中有75例没有泵功能障碍。
泵位置变化可能导致LVAD功能障碍或衰竭，但它并不能完全解释观察到的泵功能障碍或衰竭。
