Schaefer Jacob J, Sajgalik Pavol, Kushwaha Sudhir S, Olson Lyle J, Stulak John M, Johnson Bruce D, Schirger John A
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Int J Artif Organs. 2020 Jul;43(7):452-460. doi: 10.1177/0391398819899403. Epub 2020 Jan 27.
HeartMate II left ventricular assist device controllers provide data including pulsatility index, reflecting the relationship between pump function and hemodynamics. We propose that a higher pulsatility index at hospital discharge following implant may be associated with less vascular congestion and improved clinical outcomes. A retrospective analysis of 40 patients (age 59.2 ± 10.3 years) supported with the HeartMate II devices was conducted. Data revealed moderate Pearson correlations between pulsatility index at discharge and right atrial pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure, respectively, post-surgery (median of 377 days), demonstrating a stronger relationship when analyzed for the EPC controller (n = 28) only (r = -.57, p < .01; r = -.38, p < .05; r = -.59, p < .01; r = -.47, p = .01 and r = -.53, p < .01, respectively). The pulsatility index derived from the EPC controller was associated with the significant risk of re-hospitalization within 1 and 2 years after the implantation of left ventricular assist device; hazard ratio = 0.557 with 95% confidence interval (0.315-0.983), p = .04 and hazard ratio = .579 (0.341-0.984), p = .04. A higher pulsatility index at discharge was associated with greater volume unloading, lower pulmonary pressures, and lower risk of all-cause re-hospitalizations within 1 and 2 years post-surgery. As such, pump-derived data may provide additional value in predicting left ventricular assist device hemodynamics.
HeartMate II左心室辅助装置控制器提供的数据包括搏动指数，该指数反映了泵功能与血流动力学之间的关系。我们认为，植入后出院时较高的搏动指数可能与较少的血管充血和改善的临床结果相关。对40例（年龄59.2±10.3岁）接受HeartMate II装置支持的患者进行了回顾性分析。数据显示，出院时的搏动指数与术后（中位数为377天）的右心房压力、肺动脉收缩压、肺动脉舒张压、平均肺动脉压和肺毛细血管楔压之间分别存在中度Pearson相关性，仅对EPC控制器（n = 28）进行分析时显示出更强的相关性（r = -0.57，p < 0.01；r = -0.38，p < 0.05；r = -0.59，p < 0.01；r = -0.47，p = 0.01和r = -0.53，p < 0.01）。EPC控制器得出的搏动指数与左心室辅助装置植入后1年和2年内再次住院的显著风险相关；风险比=0.557，95%置信区间为（0.315 - 0.983），p = 0.04，风险比=0.579（0.341 - 0.984），p = 0.04。出院时较高的搏动指数与更大的容量卸载、更低的肺压力以及术后1年和2年内全因再次住院的较低风险相关。因此，泵衍生的数据可能在预测左心室辅助装置血流动力学方面提供额外价值。
