Division of Cardiothoracic Surgery, University of Washington Medical Center, Seattle, Wash.
Division of Cardiology, University of Washington Medical Center, Seattle, Wash.
J Thorac Cardiovasc Surg. 2017 Dec;154(6):1959-1970.e1. doi: 10.1016/j.jtcvs.2017.02.069. Epub 2017 Apr 11.
To investigate the effect of pulmonary function testing on outcomes after continuous flow left ventricular assist device implantation.
A total of 263 and 239 patients, respectively, had tests of forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide preoperatively for left ventricular assist device implantations between July 2005 and September 2015. Kaplan-Meier analysis and multivariable Cox regressions were performed to evaluate mortality. Patients were analyzed in a single cohort and across 5 groups. Postoperative intensive care unit and hospital lengths of stay were evaluated with negative binomial regressions.
There is no association of forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide with survival and no difference in mortality at 1 and 3 years between the groups (log rank P = .841 and .713, respectively). Greater values in either parameter were associated with decreased hospital lengths of stay. Only diffusing capacity of the lungs for carbon monoxide was associated with increased intensive care unit length of stay in the group analysis (P = .001). Ventilator times, postoperative pneumonia, reintubation, and tracheostomy rates were similar across the groups.
Forced expiratory volume in 1 second and diffusing capacity of the lungs for carbon monoxide are not associated with operative or long-term mortality in patients undergoing continuous flow left ventricular assist device implantation. These findings suggest that these abnormal pulmonary function tests alone should not preclude mechanical circulatory support candidacy.
研究肺功能检测对连续血流左心室辅助装置植入术后结局的影响。
分别有 263 例和 239 例患者在 2005 年 7 月至 2015 年 9 月期间接受了连续血流左心室辅助装置植入术前 1 秒用力呼气量和一氧化碳弥散量检查。采用 Kaplan-Meier 分析和多变量 Cox 回归评估死亡率。对患者进行了单队列和 5 组分析。采用负二项回归评估术后重症监护病房和住院时间。
1 秒用力呼气量和一氧化碳弥散量与生存无关,各组间 1 年和 3 年死亡率无差异(对数秩检验 P 值分别为.841 和.713)。这两个参数的值越大,住院时间越短。只有在组分析中,一氧化碳弥散量与重症监护病房住院时间延长相关(P=.001)。呼吸机使用时间、术后肺炎、再次插管和气管造口术发生率在各组间相似。
在接受连续血流左心室辅助装置植入术的患者中,1 秒用力呼气量和一氧化碳弥散量与手术或长期死亡率无关。这些发现表明,这些异常的肺功能检查单独不应排除机械循环支持的候选资格。