From the Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
Baptist Health Heart and Transplant Institute, Little Rock, Arkansas.
ASAIO J. 2019 Mar/Apr;65(3):227-232. doi: 10.1097/MAT.0000000000000840.
The PREVENtion of HeartMate II pump Thrombosis through clinical management (PREVENT) study was a multicenter, prospective investigation to evaluate the rate of pump thrombosis (PT) with adoption of a uniform set of surgical and medical practices for left ventricular assist device implantation. We sought to quantify pump position at baseline and retrospectively define a pump position associated with poor clinical outcomes. Chest x-rays at baseline were prospectively obtained per protocol. Pump pocket depth, inflow cannula (IC) angle relative to the pump, and IC angle relative to the vertical were measured. Pumps falling in the tail-ends of the IC angle and pump pocket depth distributions were categorized as having an extreme pump position within the PREVENT study. Patients with extreme pump position had a significantly higher risk of confirmed and suspected PT, hemolysis, and elevated lactate dehydrogenase. In a multivariable analysis of survival free of confirmed PT, extreme pump position was an independent risk factor (hazard ratio = 3.6; 95% confidence interval = 1.5-8.9; p = 0.006) when adjusting for differences in pump speed and anticoagulation level. Our analysis shows that HeartMate II pump position at implant can significantly impact event-free survival and the incidence of adverse events at 6 months.
通过临床管理预防 HeartMate II 泵血栓形成（PREVENT）研究是一项多中心、前瞻性研究，旨在评估采用一套统一的左心室辅助装置植入术式后的泵血栓形成（PT）发生率。我们旨在量化基线时的泵位置，并回顾性定义与不良临床结局相关的泵位置。根据方案，前瞻性地获得基线时的胸部 X 光片。测量泵袋深度、流入管（IC）相对于泵的角度以及 IC 相对于垂直方向的角度。在 PREVENT 研究中，将位于 IC 角度和泵袋深度分布尾部的泵归类为具有极端泵位置。具有极端泵位置的患者，其确诊和疑似 PT、溶血和乳酸脱氢酶升高的风险显著更高。在调整泵转速和抗凝水平差异的生存无确诊 PT 的多变量分析中，极端泵位置是一个独立的危险因素（危险比=3.6；95%置信区间=1.5-8.9；p=0.006）。我们的分析表明，HeartMate II 泵在植入时的位置会显著影响 6 个月时无事件生存率和不良事件的发生率。
