Yoshioka Daisuke, Takayama Hiroo, Garan Reshad A, Topkara Veli K, Han Jiho, Kurlansky Paul, Yuzefpolskaya Melana, Colombo Paolo C, Naka Yoshifumi, Takeda Koji
Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):828-834. doi: 10.1093/icvts/ivw409.
The timely use of a right ventricular assist device (RVAD) becomes necessary for severe right heart failure (RHF) after left ventricular assist device (LVAD) insertion. This study evaluates outcomes in patients who required unplanned RVAD support early after continuous-flow (CF) LVAD insertion.
We retrospectively reviewed 305 patients who underwent HeartMate II/HeartWare CF-LVAD insertion between 2009 and 2014. Twenty-seven (9%) patients required unplanned RVAD for severe RHF early after LVAD insertion. We compared early and late outcomes in patients with and without RVAD.
The median time to RVAD implantation after primary CF-LVAD implantation was 1.0 (0-3) day. Seventeen (63%) patients could be weaned from RVAD after median of 14 (10-18) days. In 278 patients in the isolated LVAD group, overall survival at 3 and 12 months was 95% and 86%, whereas 59% and 54% in the unplanned RVAD group, respectively ( P < 0.001). The 12-month overall survival rate in patients who were weaned from RVAD was 75% ( P = 0.189 vs isolated LVAD group), whereas in patients who could not be weaned from RVAD, the overall survival was 20% ( P < 0.001 vs RVAD weaning group and isolated LVAD group). Readmission free rate for RHF at 1 year was 53% in the unplanned RVAD group and 90% in the isolated LVAD group ( P = 0.002).
Among patients who required unplanned RVAD after CF-LVAD implantation, above 60% of the patients could be weaned from RVAD. However, careful attention should be paid to the recurrent or sustained RHF.
对于左心室辅助装置（LVAD）植入后发生的严重右心衰竭（RHF），及时使用右心室辅助装置（RVAD）变得必要。本研究评估了连续血流（CF）LVAD植入后早期需要非计划性RVAD支持的患者的结局。
我们回顾性分析了2009年至2014年间接受HeartMate II/HeartWare CF-LVAD植入的305例患者。27例（9%）患者在LVAD植入后早期因严重RHF需要非计划性RVAD。我们比较了有和没有RVAD患者的早期和晚期结局。
初次CF-LVAD植入后至RVAD植入的中位时间为1.0（0-3）天。17例（63%）患者在中位14（10-18）天后可脱离RVAD。在单纯LVAD组的278例患者中，3个月和12个月的总生存率分别为95%和86%，而在非计划性RVAD组中分别为59%和54%（P＜0.001）。脱离RVAD的患者12个月总生存率为75%（与单纯LVAD组相比，P=0.189），而不能脱离RVAD的患者总生存率为20%（与RVAD脱离组和单纯LVAD组相比，P＜0.001）。非计划性RVAD组1年时RHF再入院率为53%，单纯LVAD组为90%（P=0.002）。
在CF-LVAD植入后需要非计划性RVAD的患者中，超过60%的患者可脱离RVAD。然而，应密切关注复发性或持续性RHF。
