Goodwin Matthew, Nemeh Hassan W, Borgi Jamil, Paone Gaetano, Morgan Jeffrey A
Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan.
Division of Cardiothoracic Surgery, Heart and Vascular Institute, Henry Ford Hospital, Detroit, Michigan.
Ann Thorac Surg. 2017 Sep;104(3):811-818. doi: 10.1016/j.athoracsur.2017.02.016. Epub 2017 May 17.
Cardiac valve disease is common in patients with end-stage heart failure undergoing left ventricular assist device implantation (LVAD). The aim of this study was to determine if preoperative mitral regurgitation (MR) affects outcomes and hemodynamics in patients after LVAD implantation.
From March 2006 through May 2015, 238 consecutive patients underwent LVAD implantation. Patient cohorts included less than moderate to severe MR (< moderate-severe, n = 195) and greater than or equal to moderate to severe MR (≥ moderate-severe, n = 43). Demographics, operative characteristics, postoperative outcomes, hemodynamic and echocardiographic data, and resolution of MR were compared at 30 and 180 days post-LVAD.
Significant hemodynamic improvements were seen in central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, cardiac index, left ventricular ejection fraction, and left ventricular end-diastolic diameter, irrespective of preoperative MR severity. Significant resolution of MR occurred across both cohorts, with only 4 of 168 (2.4%) patients with ≥ moderate-severe MR at 180 days post-LVAD. There were no differences in complications or survival between MR severity cohorts postoperatively.
LVAD implantation unloads the left ventricle to promote left ventricle reverse remodeling and correct functional MR across all severity levels. The resolution of MR is sustained at 180 days post-LVAD. These results coupled with no survival difference with uncorrected MR between < moderate-severe MR and ≥ moderate-severe MR makes concomitant mitral valve repair or replacement at the time of LVAD implantation unnecessary.
心脏瓣膜疾病在接受左心室辅助装置植入（LVAD）的终末期心力衰竭患者中很常见。本研究的目的是确定术前二尖瓣反流（MR）是否会影响LVAD植入术后患者的预后和血流动力学。
从2006年3月至2015年5月，连续238例患者接受了LVAD植入。患者队列包括轻度至重度MR以下（<中度-重度，n = 195）和大于或等于中度至重度MR（≥中度-重度，n = 43）。在LVAD植入术后30天和180天比较人口统计学、手术特征、术后结局、血流动力学和超声心动图数据，以及MR的缓解情况。
无论术前MR严重程度如何，中心静脉压、肺动脉压、肺毛细血管楔压、肺血管阻力、心脏指数、左心室射血分数和左心室舒张末期直径均有显著的血流动力学改善。两个队列的MR均有显著缓解，在LVAD植入术后180天，168例≥中度-重度MR患者中只有4例（2.4%）仍有MR。术后MR严重程度队列之间的并发症或生存率没有差异。
LVAD植入减轻了左心室负荷，促进左心室逆向重构，并纠正了所有严重程度的功能性MR。MR的缓解在LVAD植入术后180天持续存在。这些结果加上<中度-重度MR和≥中度-重度MR之间未纠正MR的生存率无差异，使得在LVAD植入时同时进行二尖瓣修复或置换变得不必要。
