Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ichinomiya Municipal Hospital, Ichinomiya, Japan.
Int J Artif Organs. 2020 Sep;43(9):594-599. doi: 10.1177/0391398820901841. Epub 2020 Jan 31.
In the management of venoarterial extracorporeal membrane oxygenation, some patients present persistently closed aortic valve. However, little is known about the variables that contribute to persistently closed aortic valve. We investigated the factors that could predict persistently closed aortic valve at the time of venoarterial extracorporeal membrane oxygenation initiation. We investigated 17 patients who presented closed aortic valve immediately after the introduction of venoarterial extracorporeal membrane oxygenation. Patients who presented closed aortic valve 24 h after introduction of venoarterial extracorporeal membrane oxygenation were defined as the Closed-AV group (n = 8), while those whose aortic valve remained opened after 24 h were defined as the Open-AV group (n = 9). All patients were managed by concomitant use of intra-aortic balloon pumping. At baseline, there were no significant differences between mean arterial blood pressure, central venous pressure, and left ventricular ejection fraction. However, Closed-AV group had significantly lower mean pulmonary artery pressure and pulmonary artery pulse pressure compared to those of Open-AV group (mean pulmonary artery pressure: 15 ± 6 mmHg vs 25 ± 8 mmHg, p = 0.01; pulmonary artery pulse pressure: 3 ± 2 mmHg vs 8 ± 3 mmHg, p < 0.01). Logistic regression analyses revealed that the lower mean pulmonary artery pressure and pulmonary artery pulse pressure had the predictive value of closed aortic valve within 24 h after venoarterial extracorporeal membrane oxygenation initiation (mean pulmonary artery pressure: odds ratio = 0.78, 95% confidence interval = 0.58-0.95, p < 0.01; pulmonary artery pulse pressure: odds ratio = 0.18, 95% confidence interval = 0.01-0.61, p < 0.01). Lower mean pulmonary artery pressure and pulmonary artery pulse pressure values could predict persistent closed aortic valve 24 h after venoarterial extracorporeal membrane oxygenation initiation. Left ventricular preload derived from right heart function may have a major impact on aortic valve status.
在静脉动脉体外膜肺氧合的管理中，一些患者的主动脉瓣持续关闭。然而，对于导致主动脉瓣持续关闭的变量知之甚少。我们研究了静脉动脉体外膜肺氧合启动时可预测主动脉瓣持续关闭的因素。我们调查了 17 名在引入静脉动脉体外膜肺氧合后立即出现主动脉瓣关闭的患者。在引入静脉动脉体外膜肺氧合 24 小时后出现主动脉瓣关闭的患者被定义为关闭 AV 组（n=8），而在 24 小时后主动脉瓣仍保持开放的患者被定义为开放 AV 组（n=9）。所有患者均通过同时使用主动脉内球囊反搏进行管理。在基线时，平均动脉血压、中心静脉压和左心室射血分数没有显著差异。然而，关闭 AV 组的平均肺动脉压和肺动脉脉压明显低于开放 AV 组（平均肺动脉压：15±6mmHg 比 25±8mmHg，p=0.01；肺动脉脉压：3±2mmHg 比 8±3mmHg，p<0.01）。Logistic 回归分析显示，较低的平均肺动脉压和肺动脉脉压在静脉动脉体外膜肺氧合启动后 24 小时内具有主动脉瓣关闭的预测价值（平均肺动脉压：优势比=0.78，95%置信区间=0.58-0.95，p<0.01；肺动脉脉压：优势比=0.18，95%置信区间=0.01-0.61，p<0.01）。较低的平均肺动脉压和肺动脉脉压值可预测静脉动脉体外膜肺氧合启动后 24 小时持续主动脉瓣关闭。来自右心功能的左心室前负荷可能对主动脉瓣状态有重大影响。
