Division of Cardiothoracic Surgery, University of Iowa Health Care, Iowa City, Iowa.
University of Pittsburgh School of Medicine, Pittsburgh, Pa.
J Thorac Cardiovasc Surg. 2018 Nov;156(5):1885-1891. doi: 10.1016/j.jtcvs.2018.04.094. Epub 2018 May 1.
This study sought to determine if indication for support affects the outcomes after temporary right ventricular mechanical circulatory support after postcardiotomy cardiogenic shock, cardiac transplant, or left ventricular assist device placement.
A retrospective review was performed on 80 patients receiving a right ventricular assist device. Data were collected from a prospectively maintained database. Kaplan-Meier survival analysis was performed to compare survival between groups. Multivariate regression analysis was performed to identify risk factors for failure to wean from support.
The indication for support was postcardiotomy cardiogenic shock in 13 patients (16%), cardiac transplant in 25 patients (31%), and left ventricular assist device in 42 patients (53%). Median support time was 6 days. Device was successfully weaned in 6 postcardiotomy cardiogenic shock cases (46%), 21 cardiac transplant cases (84%), and 35 left ventricular assist device cases (83%). Survival was worse for patients with postcardiotomy cardiogenic shock compared with patients with a left ventricular assist device. Survival up to 3 months was better for patients who received immediate (n = 43) versus delayed (n = 37) support (79% vs 46%, P = .003). Weaning and survival remained static across implant era. Risk factor analysis identified postcardiotomy cardiogenic shock indication (odds ratio, 0.161; P = .007; confidence interval, 0.043-0.600) as an independent negative predictor of weaning from mechanical support.
Temporary right ventricular mechanical support remains an effective treatment strategy after left ventricular assist device placement with immediate support resulting in superior short-term survival. Caution should be applied in postcardiotomy cardiogenic shock when weaning and survival are poor. Overall survival outcomes have remained relatively static over time.
本研究旨在确定在心脏手术后心源性休克、心脏移植或左心室辅助装置（LVAD）植入后接受临时右心室机械循环支持的适应证是否会影响预后。
对 80 例接受右心室辅助装置（RVAD）治疗的患者进行回顾性研究。数据来自前瞻性维护的数据库。采用 Kaplan-Meier 生存分析比较各组间的生存情况。采用多变量回归分析确定无法脱机的危险因素。
支持的适应证为心脏手术后心源性休克 13 例（16%）、心脏移植 25 例（31%）和 LVAD 42 例（53%）。中位支持时间为 6 天。心脏手术后心源性休克成功脱机 6 例（46%）、心脏移植成功脱机 21 例（84%）、LVAD 成功脱机 35 例（83%）。与 LVAD 相比，心脏手术后心源性休克患者的生存情况更差。接受即刻（n=43）与延迟（n=37）支持的患者在 3 个月时的生存率更高（79% vs 46%，P=0.003）。在不同的植入时代，脱机和生存率均保持稳定。危险因素分析发现，心脏手术后心源性休克的适应证（比值比，0.161；P=0.007；置信区间，0.043-0.600）是机械支持脱机的独立负预测因素。
在 LVAD 植入后，临时右心室机械支持仍然是一种有效的治疗策略，即刻支持可显著提高短期生存率。在心脏手术后心源性休克患者中应谨慎进行脱机治疗，因为脱机和生存率均较差。总的生存结果随着时间的推移相对保持稳定。
