Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA.
Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
J Artif Organs. 2021 Jun;24(2):182-190. doi: 10.1007/s10047-020-01229-1. Epub 2021 Jan 18.
Left ventricular assist devices (LVADs) are associated with major vascular complications including stroke and gastrointestinal bleeding (GIB). These adverse vascular events may be the result of widespread vascular dysfunction resulting from pre-LVAD abnormalities or continuous flow during LVAD therapy. We hypothesized that pre-existing large artery atherosclerosis and/or abnormal blood flow as measured in carotid arteries using ultrasonography are associated with a post-implantation composite adverse outcome including stroke, GIB, or death. We retrospectively studied 141 adult HeartMate II patients who had carotid ultrasound duplex exams performed before and/or after LVAD surgery. Structural parameters examined included plaque burden and stenosis. Hemodynamic parameters included peak-systolic, end-diastolic, and mean velocity as well as pulsatility index. We examined the association of these measures with the composite outcome as well as individual subcomponents such as stroke. After adjusting for established risk factors, the composite adverse outcome was associated with pre-operative moderate-to-severe carotid plaque (OR 5.08, 95% CI 1.67-15.52) as well as pre-operative internal carotid artery stenosis (OR 9.02, 95% CI 1.06-76.56). In contrast, altered hemodynamics during LVAD support were not associated with the composite outcome. Our findings suggest that pre-existing atherosclerosis possibly in combination with LVAD hemodynamics may be an important contributor to adverse vascular events during mechanical support. This encourages greater awareness of carotid morphology pre-operatively and further study of the interaction between hemodynamics, pulsatility, and structural arterial disease during LVAD support.
左心室辅助装置（LVAD）与重大血管并发症有关，包括中风和胃肠道出血（GIB）。这些不良血管事件可能是由于 LVAD 治疗前的广泛血管功能障碍或持续的血流引起的。我们假设，预先存在的大动脉粥样硬化和/或使用超声测量颈动脉的异常血流与包括中风、GIB 或死亡在内的植入后复合不良结局有关。我们回顾性研究了 141 名成年 HeartMate II 患者，他们在 LVAD 手术后进行了颈动脉超声双工检查。检查的结构参数包括斑块负担和狭窄。血流动力学参数包括收缩期峰值、舒张末期和平均速度以及搏动指数。我们研究了这些措施与复合结局以及中风等个别亚成分的关系。在调整了既定的危险因素后，复合不良结局与术前中度至重度颈动脉斑块（OR 5.08，95%CI 1.67-15.52）以及术前颈内动脉狭窄（OR 9.02，95%CI 1.06-76.56）有关。相比之下，LVAD 支持期间的血流动力学改变与复合结局无关。我们的发现表明，预先存在的动脉粥样硬化可能与 LVAD 血流动力学一起，是机械支持期间不良血管事件的重要原因。这鼓励在术前更多地了解颈动脉形态，并进一步研究 LVAD 支持期间血流动力学、脉动性和结构性动脉疾病之间的相互作用。
