Shehab Sajad, Allida Sabine M, Davidson Patricia M, Newton Phillip J, Robson Desiree, Jansz Paul C, Hayward Christopher S
From the *Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; †Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia; ‡School of Nursing, Johns Hopkins University, Baltimore, Maryland; §Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; and ¶School of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
ASAIO J. 2017 Jan/Feb;63(1):41-47. doi: 10.1097/MAT.0000000000000455.
Right ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. Management remains limited to pharmacologic therapy and temporary mechanical support. Delayed right ventricular assist device (RVAD) support after LVAD implantation is associated with poorer outcomes. With the advent of miniaturized, durable, continuous flow ventricular assist device systems, chronic RVAD and biventricular assist device (BiVAD) support has been used with some success. The purpose of this study was to assess combined BiVAD and LVAD with delayed RVAD support within a four-elemental mock circulatory loop (MCL) simulating the human cardiovascular system. Our hypothesis was that delayed continuous flow RVAD (RVAD) would produce similar hemodynamic and flow parameters to those of initial BiVAD support. Using the MCL, baseline biventricular heart failure with elevated right and left filling pressures with low cardiac output was simulated. The addition of LVAD within a biventricular configuration improved cardiac output somewhat, but was associated with persistent right heart failure with elevated right-sided filling pressures. The addition of an RVAD significantly improved LVAD outputs and returned filling pressures to normal throughout the circulation. In conclusion, RVAD support successfully restored hemodynamics and flow parameters of biventricular failure supported with isolated LVAD with persistent elevated right atrial pressure.
左心室辅助装置（LVAD）植入术后发生右心室衰竭与高死亡率相关。治疗方法仍局限于药物治疗和临时机械支持。LVAD植入术后延迟使用右心室辅助装置（RVAD）支持与较差的预后相关。随着小型化、耐用、连续流式心室辅助装置系统的出现，慢性RVAD和双心室辅助装置（BiVAD）支持已取得一定成功。本研究的目的是在模拟人体心血管系统的四要素模拟循环回路（MCL）中评估联合BiVAD和LVAD并延迟使用RVAD支持的情况。我们的假设是延迟的连续流式RVAD将产生与初始BiVAD支持相似的血流动力学和流量参数。使用MCL模拟了基线双心室心力衰竭，伴有左右充盈压升高和低心输出量。在双心室配置中添加LVAD在一定程度上改善了心输出量，但与持续的右心衰竭及右侧充盈压升高相关。添加RVAD显著改善了LVAD的输出，并使整个循环中的充盈压恢复正常。总之，RVAD支持成功恢复了孤立LVAD支持且右心房压力持续升高的双心室衰竭的血流动力学和流量参数。
