HeartMate 3左心室辅助装置支持期间的主动脉瓣关闭不全
Aortic Insufficiency During HeartMate 3 Left Ventricular Assist Device Support.
作者信息
Imamura Teruhiko, Narang Nikhil, Kim Gene, Nitta Daisuke, Fujino Takeo, Nguyen Ann, Grinstein Jonathan, Rodgers Daniel, Ota Takeyoshi, Jeevanandam Valluvan, Sayer Gabriel, Uriel Nir
机构信息
(1)Department of Medicine, University of Chicago Medical Center, Chicago, Illinois; Second Department of Medicine, University of Toyama, Toyama, Japan.
Division of Advocate Christ Medical Center, Oak Lawn, Illinois.
出版信息
J Card Fail. 2020 Oct;26(10):863-869. doi: 10.1016/j.cardfail.2020.05.013. Epub 2020 May 27.
BACKGROUND
Aortic insufficiency (AI) is associated with morbidity and mortality in patients with continuous-flow left ventricular assist devices (LVADs), whereas its impact on the HeartMate 3 LVAD cohorts remains uninvestigated. We aimed to investigate the clinical impact of AI on patients with HeartMate 3 LVADs.
METHODS AND RESULTS
Consecutive 61 patients (median age 54 years; 67% male) implanted with HeartMate 3 LVAD between 2015 and 2019 were enrolled and underwent echocardiography at 3 months after LVAD implantation. AI severity was quantified by the novel Doppler echocardiographic method obtained at the outflow cannula and the calculated regurgitation fraction of 30% or greater (moderate or greater) was defined as significant. At 3 months after implant, 12 patients (20%) had significant AI. They had a higher incidence of death or heart failure readmissions compared with those without significant AI during a 1-year observational period (70% vs 24%, P = .003) with an adjusted hazard ratio of 2.76 (95% confidence interval 1.03-7.88).
CONCLUSIONS
In patients with HeartMate 3 LVAD support, significant AI remains both prevalent and a clinically significant downstream complication.
背景
主动脉瓣关闭不全（AI）与持续血流左心室辅助装置（LVAD）患者的发病率和死亡率相关，但其对HeartMate 3 LVAD队列的影响仍未得到研究。我们旨在研究AI对HeartMate 3 LVAD患者的临床影响。
方法和结果
纳入2015年至2019年间连续植入HeartMate 3 LVAD的61例患者（中位年龄54岁；67%为男性），并在LVAD植入后3个月进行超声心动图检查。通过在流出道插管处采用新型多普勒超声心动图方法对AI严重程度进行量化，计算出的反流分数≥30%（中度或更严重）定义为显著AI。植入后3个月时，12例患者（20%）有显著AI。在1年观察期内，与无显著AI的患者相比，他们死亡或因心力衰竭再次入院的发生率更高（70%对24%，P = 0.003），校正风险比为2.76（95%置信区间1.03 - 7.88）。
结论
在接受HeartMate 3 LVAD支持的患者中，显著AI仍然普遍存在且是具有临床意义的下游并发症。
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