Eulert-Grehn Jaime-Jürgen, Lanmüller Pia, Schönrath Felix, Solowjowa Natalia, Müller Marcus, Mulzer Johanna, Kaufmann Friedrich, Starck Christoph, Krabatsch Thomas, Falk Volkmar, Potapov Evgenij
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
Interact Cardiovasc Thorac Surg. 2018 Dec 1;27(6):938-942. doi: 10.1093/icvts/ivy228.
No continuous-flow right ventricular assist device for long-term support is available at the moment. Two continuous-flow ventricular assist devices used in a continuous-flow biventricular assist device configuration is an emerging option which has proven its feasibility but still is not approved for routine use. We present our technique and results of modifying the left ventricular assist device and making it suitable for right ventricular support.
Between September 2009 and October 2017, 39 patients received implantation of a continuous-flow ventricular assist device for right ventricular support in a continuous-flow biventricular assist device configuration. For implantation of the HeartWare® manufacturers name of the pump HeartWare HVAD pump (HVAD)® centrifugal ventricular assist device, we performed 2 major modifications: banding of the outflow graft and reducing the intracaval length of the inflow cannula. The HVAD® could be safely implanted into the right atrium or ventricle. The HeartMate 3® left ventricular assist device needed no banding, but we increased the extraventricular part of the inflow cannula.
The overall 30-day survival for the group receiving primarily a continuous-flow biventricular assist device was 72.7% (9.5% standard error of the mean (SEM)), and the 1-year survival was 45.0% (10.7% SEM). The overall 30-day survival for the group receiving a subsequent pump for right ventricular support in a continuous-flow biventricular assist device configuration after temporary right ventricular support was 71.4% (12.1% SEM), and 1-year survival was 40.8% (13.6% SEM).
At the moment, there is a lack of a continuous-flow right ventricular assist device especially designed and approved for right ventricular support. Therefore, modifications in continuous-flow ventricular assist devices designed for the left ventricle are done to make them suitable for right ventricular support. However, more information is needed regarding the optimal surgical technique, patient selection and the optimal time point of implantation.
目前尚无用于长期支持的连续流右心室辅助装置。在连续流双心室辅助装置配置中使用两个连续流心室辅助装置是一种新兴的选择，已证明其可行性，但仍未获批用于常规使用。我们展示了我们修改左心室辅助装置并使其适用于右心室支持的技术和结果。
2009年9月至2017年10月期间，39例患者接受了连续流双心室辅助装置配置下用于右心室支持的连续流心室辅助装置植入术。对于植入HeartWare®泵（HeartWare HVAD泵（HVAD）®）离心式心室辅助装置，我们进行了两项主要修改：流出道移植物绑扎和缩短流入插管的腔静脉内长度。HVAD®可以安全地植入右心房或右心室。HeartMate 3®左心室辅助装置无需绑扎，但我们增加了流入插管的心室外部部分。
主要接受连续流双心室辅助装置的组的总体30天生存率为72.7%（平均标准误差（SEM）为9.5%），1年生存率为45.0%（SEM为10.7%）。在临时右心室支持后接受连续流双心室辅助装置配置下用于右心室支持的后续泵的组的总体30天生存率为71.4%（SEM为12.1%），1年生存率为40.8%（SEM为13.6%）。
目前，缺乏专门设计并获批用于右心室支持的连续流右心室辅助装置。因此，对为左心室设计的连续流心室辅助装置进行修改，使其适用于右心室支持。然而，关于最佳手术技术、患者选择和最佳植入时间点，还需要更多信息。
