From the Department of Medicine; University of Chicago Medical Center, Chicago, Illinois.
Department of Surgery, University of Chicago Medical Center, Chicago, Illinois.
ASAIO J. 2020 Apr;66(4):355-361. doi: 10.1097/MAT.0000000000000999.
There are conflicting data regarding whether concomitant mitral valve surgery (MVS) at left ventricular assist device (LVAD) implantation is beneficial. This study aimed to assess the hemodynamic effects of concomitant MVS. Of all 73 enrolled patients, 44 patients had undergone concomitant MVS and 29 patients had not. Before LVAD implantation, MVS group had higher pulmonary capillary wedge pressure (p = 0.04). After LVAD implantation, MVS group had higher mean pulmonary artery pressure and cardiac output (CO). During the hemodynamic ramp study, MVS group had steeper CO slopes (0.18 [0.13 0.28] vs. 0.15 [0.08, 0.20] L/min/step; p = 0.04) at incremental LVAD speed and achieved a higher CO at the optimized set speed (5.5 [4.7, 6.9] vs. 4.9 [4.0, 5.7] L/min; p = 0.03). One-year freedom from death or heart failure readmission was statistically comparable between the two groups (61% vs. 80%, p = 0.20). Thus far, after LVAD implantation and concomitant MVS, patients had increased pulmonary hypertension, despite having higher CO and a better response of CO at incremental LVAD speed. The implication of hemodynamic features after concomitant MVS on clinical outcomes warrants further investigation.
关于在左心室辅助装置（LVAD）植入时同时进行二尖瓣手术（MVS）是否有益，目前存在相互矛盾的数据。本研究旨在评估同时进行 MVS 的血流动力学效应。在所有纳入的 73 名患者中，44 名患者接受了同时 MVS，29 名患者未接受。在 LVAD 植入前，MVS 组的肺毛细血管楔压更高（p = 0.04）。在 LVAD 植入后，MVS 组的平均肺动脉压和心输出量（CO）更高。在血流动力学斜坡研究中，MVS 组的 CO 斜率更陡（0.18 [0.13 0.28] vs. 0.15 [0.08, 0.20] L/min/步；p = 0.04），在递增的 LVAD 速度下达到更高的 CO，在优化的设定速度下达到更高的 CO（5.5 [4.7, 6.9] vs. 4.9 [4.0, 5.7] L/min；p = 0.03）。两组之间 1 年免于死亡或心力衰竭再入院的生存率无统计学差异（61% vs. 80%，p = 0.20）。迄今为止，在 LVAD 植入和同时进行 MVS 后，尽管 CO 更高，并且 CO 对递增的 LVAD 速度的反应更好，但患者的肺动脉高压仍有所增加。同时进行 MVS 后血流动力学特征对临床结果的影响值得进一步研究。
