Matsumoto Yorihiko, Fukushima Satsuki, Shimahara Yusuke, Kawamoto Naonori, Tadokoro Naoki, Kuroda Kensuke, Nakajima Seiko, Watanabe Takuya, Seguchi Osamu, Yanase Masanobu, Fukushima Norihide, Shimizu Hideyuki, Kobayashi Junjiro, Fujita Tomoyuki
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan.
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
J Artif Organs. 2020 Mar;23(1):19-26. doi: 10.1007/s10047-019-01129-z. Epub 2019 Sep 4.
Hemolysis is closely related with pump thrombosis and thromboembolic events in patients with continuous flow left ventricular assist devices. We retrospectively investigated the impact of early postoperative heparinization on hemolysis in patients with HeartMate II devices. From April 2013 to August 2017, 83 patients (age 45 ± 12 years; 20 females; body surface area 1.6 ± 0.2 m) underwent HeartMate II implantation. Postoperative heparinization was started when hemostasis was achieved and continued until full warfarinization. Hemolysis was defined in accordance with the Interagency Registry for Mechanically Assisted Circulatory Support definitions. The average support period was 22 ± 14 months. The 6-, 12-, and 24-month freedoms from hemolysis were 72%, 70%, and 67%, respectively. Pump thrombosis developed in five (6%) patients and four (5%) required pump exchanges. Heparin start time was significantly later in patients with hemolysis (43 ± 23 h after implantation) versus those without (29 ± 14 h after implantation; p = 0.01). Receiver operating characteristic analysis determined the cut-off point of heparin start time as 29 h. The patients were divided into the early group (heparin start time < 29 h; n = 29), and the late group (heparin start time > 29 h; n = 54). The respective 6-, 12-, and 24-month freedoms from hemolysis for the early group (86%, 86%, and 86%, respectively) were significantly higher than those for the late group (49%, 47%, and 44%, respectively; p = 0.002). Being in the late group was an independent risk factor for hemolysis (hazard ratio 4.09). Early postoperative heparinization (within 29 h after implantation) reduces hemolysis in patients with HeartMate II devices.
溶血与持续血流左心室辅助装置患者的泵血栓形成及血栓栓塞事件密切相关。我们回顾性研究了术后早期肝素化对使用HeartMate II装置患者溶血的影响。2013年4月至2017年8月，83例患者（年龄45±12岁；女性20例；体表面积1.6±0.2平方米）接受了HeartMate II植入术。术后在止血完成后开始肝素化，并持续至华法林完全起效。溶血根据机械辅助循环支持机构间注册中心的定义来界定。平均支持时间为22±14个月。6个月、12个月和24个月无溶血生存率分别为72%、70%和67%。5例（6%）患者发生泵血栓形成，4例（5%）需要更换泵。发生溶血的患者肝素开始时间（植入后43±23小时）显著晚于未发生溶血的患者（植入后29±14小时；p=0.01）。受试者工作特征分析确定肝素开始时间的截断点为29小时。患者被分为早期组（肝素开始时间<29小时；n=29）和晚期组（肝素开始时间>29小时；n=54）。早期组6个月、12个月和24个月无溶血生存率（分别为86%、86%和86%）显著高于晚期组（分别为49%、47%和44%；p=0.002）。处于晚期组是溶血的独立危险因素（风险比4.09）。术后早期肝素化（植入后29小时内）可降低使用HeartMate II装置患者的溶血发生率。
