Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany.
J Heart Lung Transplant. 2019 Apr;38(4):440-448. doi: 10.1016/j.healun.2018.11.001. Epub 2018 Nov 15.
In this retrospective analysis we evaluated a standardized echocardiographic assessment and an invasive technique for patient selection for successful continuous-flow left ventricular assist device (CF-LVAD) explantation.
Inclusion criteria for LVAD recovery assessment were: clinically stable condition; LVAD support for >6 months; physical activity; normal echocardiography findings; and no more than mild valvular disease and aortic valve opening. In a second step, echocardiography was performed under CF-LVAD reduction and stop conditions (PStopE). In the third step, patients who presented with stable parameters underwent right heart catheterization under CF-LVAD stoppage and occlusion of the outflow graft with a balloon catheter. Criteria for explantation were normal pulmonary artery pressure and pulmonary capillary wedge pressure <16 mmHg.
Thirty-three of 424 patients entered the second step of evaluation and 20 entered the third step. Fourteen presented positive results and the pump was successfully explanted. The PCWP at baseline was 8.5 (2.8) mmHg in the explantation group and 10.6 (2.8) mmHg in the non-explantation group (p = 0.105). It increased to 10.9 (3.0) mmHg vs 20.8 (4.9) mmHg under outflow graft occlusion. The wedge pressure was significantly higher in the non-explantation group (p < 0.001). Median duration of follow-up after explantation was 9.74 (interquartile range 4.3 to 20.60) months, with survival of 93%.
The protocol presented is feasible and safe. The criteria applied provide good patient selection for sustained mid-term myocardial recovery after LVAD explantation.
在这项回顾性分析中，我们评估了标准化超声心动图评估和一种侵袭性技术，以选择成功进行持续血流左心室辅助装置（CF-LVAD）取出的患者。
LVAD 恢复评估的纳入标准为：临床稳定状态；LVAD 支持 >6 个月；体力活动；超声心动图检查结果正常；且瓣叶疾病和主动脉瓣开口不超过轻度。在第二步中，在 CF-LVAD 减少和停止条件下（PStopE）进行超声心动图检查。在第三步中，参数稳定的患者在 CF-LVAD 停止和用球囊导管阻塞流出道移植物的情况下进行右心导管检查。取出的标准为肺动脉压和肺毛细血管楔压正常<16mmHg。
424 例患者中的 33 例进入评估的第二步，20 例进入第三步。14 例结果阳性，成功取出泵。在取出组中，基线时 PCWP 为 8.5（2.8）mmHg，在未取出组中为 10.6（2.8）mmHg（p=0.105）。在流出道移植物阻塞时，PCWP 增加到 10.9（3.0）mmHg 对 20.8（4.9）mmHg。在未取出组中，楔压明显更高（p<0.001）。取出后中位随访时间为 9.74 个月（四分位距 4.3 至 20.60），存活率为 93%。
提出的方案是可行且安全的。应用的标准为 LVAD 取出后持续中期心肌恢复提供了良好的患者选择。
