Ranganath Neel K, Smith Deane E, Moazami Nader
Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York, USA.
Curr Opin Organ Transplant. 2018 Jun;23(3):295-300. doi: 10.1097/MOT.0000000000000528.
Many patients suffer from either persistent right ventricular failure (RVF) at the time of left ventricular assist device (LVAD) or have ongoing symptoms consistent with RVF during chronic mechanical circulatory support. The lack of long-term right ventricular assist devices (RVADs) has limited the impact that mechanical circulatory support can provide to patients with biventricular failure. We aim to review the entire spectrum of RVF in patients receiving LVADs and reflect on why this entity remains the Achilles' heel of LVAD therapy.
In the early postoperative period, LVAD implantation reduces right ventricle (RV) afterload, but RV dysfunction may be exacerbated secondary to increased venous return. With prolonged therapy, the decreased RV afterload leads to improved RV contractile function. Bayesian statistical models outperform previously published preoperative risk scores by considering inter-relationships and conditional probabilities amongst independent variables. Various echocardiographic parameters and the pulmonary artery pulsatility index have shown promise in predicting post-LVAD RVF. Recent publications have delineated the emergence of 'delayed' RVF. Several devices are currently being investigated for use as RVADs.
Post-LVAD RVF depends on the RV's ability to adapt to acute hemodynamic changes imposed by the LVAD. Management options are limited due to the lack of an easily implantable, chronic-use RVAD.
许多患者在植入左心室辅助装置（LVAD）时即患有持续性右心室衰竭（RVF），或在慢性机械循环支持期间出现与RVF相符的持续症状。长期右心室辅助装置（RVAD）的缺乏限制了机械循环支持对双心室衰竭患者的治疗效果。我们旨在综述接受LVAD治疗患者的RVF全貌，并思考为何这一问题仍是LVAD治疗的薄弱环节。
术后早期，LVAD植入可降低右心室（RV）后负荷，但由于静脉回流增加，RV功能障碍可能会加重。随着治疗时间延长，RV后负荷降低可改善RV收缩功能。贝叶斯统计模型通过考虑自变量之间的相互关系和条件概率，其表现优于先前发表的术前风险评分。各种超声心动图参数和肺动脉搏动指数在预测LVAD植入后RVF方面显示出前景。近期出版物已阐明“延迟性”RVF的出现。目前正在研究几种用作RVAD的装置。
LVAD植入后的RVF取决于RV适应LVAD引起的急性血流动力学变化的能力。由于缺乏易于植入、可长期使用的RVAD，治疗选择有限。
