Jakovljevic Djordje G, Yacoub Magdi H, Schueler Stephan, MacGowan Guy A, Velicki Lazar, Seferovic Petar M, Hothi Sandeep, Tzeng Bing-Hsiean, Brodie David A, Birks Emma, Tan Lip-Bun
Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, and Clinical Research Facility, Newcastle Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom.
Imperial College London, London, United Kingdom.
J Am Coll Cardiol. 2017 Apr 18;69(15):1924-1933. doi: 10.1016/j.jacc.2017.02.018.
Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery.
This study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls.
Fifty-eight male patients-18 implanted with a continuous-flow LVAD, 16 patients with LVAD explanted (recovered patients), and 24 heart transplant candidates (HTx)-and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) hemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure × cardiac output) and functional capacity by peak exercise O consumption.
All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD patients compared with other patients (healthy 5.35 ± 0.95 W; explanted 3.45 ± 0.72 W; LVAD implanted 2.37 ± 0.68 W; and HTx 1.31 ± 0.31 W; p < 0.05), as was peak O consumption (healthy 36.4 ± 10.3 ml/kg/min; explanted 29.8 ± 5.9 ml/kg/min; implanted 20.5 ± 4.3 ml/kg/min; and HTx 12.0 ± 2.2 ml/kg/min; p < 0.05). In the LVAD explanted group, 38% of the patients achieved peak cardiac power output and 69% achieved peak O consumption within the ranges of healthy controls.
The authors have shown that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls.
左心室辅助装置（LVAD）已被用作晚期心力衰竭患者的一种有效治疗选择，可作为移植桥梁、终末期治疗，或在某些患者中作为恢复桥梁。
本研究评估接受LVAD恢复桥梁方案的患者是否能够实现与健康对照者相当的心脏和身体功能能力。
58例男性患者——18例植入连续流LVAD，16例LVAD已移除（康复患者），24例心脏移植候选者（HTx）——以及97例健康对照者进行了最大分级心肺运动试验，连续测量呼吸气体交换和无创（重复呼吸）血流动力学数据。心脏功能以运动峰值心输出功率（平均动脉血压×心输出量）表示，功能能力以运动峰值耗氧量表示。
所有患者均表现出显著的运动努力，平均运动峰值呼吸交换率>1.10。与其他患者相比，健康对照者和LVAD已移除患者的运动峰值心输出功率显著更高（健康者5.35±0.95W；已移除者3.45±0.72W；植入LVAD者2.37±0.68W；HTx患者1.31±0.31W；p<0.05），运动峰值耗氧量也是如此（健康者36.4±10.3ml/kg/min；已移除者29.8±5.9ml/kg/min；植入者20.5±4.3ml/kg/min；HTx患者12.0±2.2ml/kg/min；p<0.05）。在LVAD已移除组中，38%的患者运动峰值心输出功率以及69%的患者运动峰值耗氧量达到了健康对照者的范围。
作者表明，相当数量的患者恢复到足以移除LVAD，甚至能够实现与健康对照者几乎相当的心脏和身体功能能力。
