Schaefer Andreas, Reichart Daniel, Bernhardt Alexander M, Kubik Mathias, Barten Markus J, Wagner Florian M, Reichenspurner Hermann, Philipp Sebastian A, Deuse Tobias
From the *Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany; †Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany; ‡Department of Cardiology and Intensive Care Medicine, Elbe Clinic Stade, Niedersachsen, Germany; and §Department of Cardiac Surgery, Division of Adult Cardiothoracic Surgery, Cardiac Surgery, University of California San Francisco, San Francisco, California.
ASAIO J. 2017 Sep/Oct;63(5):546-550. doi: 10.1097/MAT.0000000000000526.
Right ventricular failure (RVF) may still occur despite the benefits of minimally invasive left ventricular assist device (MI-LVAD) implantation. Our center strategy aims to avoid aggressive postoperative inotrope use by using mechanical support to facilitate right ventricle recovery and adaptation. We herein report first outcomes of patients with minimally invasive temporary right ventricular assist device (MI-t-RVAD) support for RVF during MI-LVAD implantation. Right ventricular failure was defined as requiring more than moderate inotopic support after weaning from cardiopulmonary bypass according to Interagency Registry for Mechanically Assisted Circulatory Support adverse event definitions. All patients requiring MI-t-RVAD support for RVF during MI-LVAD implantation between January, 2012 and April, 2016 were retrospectively reviewed. Clinical endpoints were death or unsuccessful RVAD weaning. Overall 10 patients (90% male, mean age 49.6 ± 14.8 years) underwent MI-t-RVAD implantation. Duration of MI-t-RVAD support was 16.2 ± 11.6 days. Right ventricular assist device weaning and subsequent uneventful awake device explantation was successful in all cases. The 30 day survival was 80%. Our results confirm safety and feasibility of MI-t-RVAD support for acute RVF in the setting of MI-LVAD implantation. The potential benefits of this strategy are more stable hemodynamics in the first postoperative days that usually are crucial for LVAD patients and reduced inotrope requirement.
尽管植入微创左心室辅助装置（MI-LVAD）有诸多益处，但仍可能发生右心室衰竭（RVF）。我们中心的策略旨在通过使用机械支持来促进右心室恢复和适应，避免术后过度使用血管活性药物。在此，我们报告在MI-LVAD植入期间使用微创临时右心室辅助装置（MI-t-RVAD）支持RVF患者的初步结果。根据机械辅助循环支持机构间注册中心的不良事件定义，右心室衰竭定义为在体外循环停机后需要超过中度的血管活性药物支持。对2012年1月至2016年4月期间在MI-LVAD植入期间需要MI-t-RVAD支持RVF的所有患者进行回顾性分析。临床终点为死亡或RVAD撤机失败。共有10例患者（90%为男性，平均年龄49.6±14.8岁）接受了MI-t-RVAD植入。MI-t-RVAD支持的持续时间为16.2±11.6天。所有病例中，右心室辅助装置撤机及随后顺利清醒状态下取出装置均成功。30天生存率为80%。我们的结果证实了MI-t-RVAD支持在MI-LVAD植入背景下治疗急性RVF的安全性和可行性。该策略的潜在益处是术后最初几天血流动力学更稳定，这通常对LVAD患者至关重要，以及减少血管活性药物的需求。
