Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY, USA.
Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY, USA.
Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1166-1173. doi: 10.1093/ejcts/ezaa475.
This study analyses the position of the HeartMate 3 left ventricular assist device on serial radiographs to assess positional change and possible correlation with adverse events.
We retrospectively analysed 59 left ventricular assist device recipients who had serial chest radiographs at 1 month, 6 months and 12 months post-implantation between November 2014 and June 2018. We measured pump angle, pump-spine distance and pump-diaphragm depth and investigated their relationship to a composite outcome of heart failure readmission, low flow alarms, stroke or inflow/outflow occlusion requiring surgical repositioning through recurrent event survival modelling.
Between 1 and 6 months, the absolute pump-spine distance changed by 10.00 mm (P < 0.01) and the absolute pump-diaphragm depth changed by 18.80 mm (P < 0.01). These parameters did not change significantly between 6 and 12 months post-implantation. Pump angle did not change significantly over any period. Twenty-six patients experienced the composite outcome; in these patients, the median 1-month pump angle was 66.2° (interquartile range 54.5-78.0) as compared to 59.0° (interquartile range 47.0-65.0) in the 33 patients who did not have adverse events (P = 0.04). Pump depth and pump-spine distance at 1 month were not associated with the composite outcome. Change in pump depth between 1 and 6 months [hazard ratio (HR) 1.019; 95% confidence interval (CI) 1.000-1.039] and between 6 and 12 months (HR 1.020; 95% CI 1.000-1.040) were weakly associated with the composite outcome.
Larger pump angles are associated with the composite outcome of position-related adverse events. Pump depth movement is weakly associated with the composite outcome.
本研究通过分析 HeartMate 3 左心室辅助装置在连续 X 光片上的位置，评估位置变化及其与不良事件的可能相关性。
我们回顾性分析了 2014 年 11 月至 2018 年 6 月期间 59 例接受左心室辅助装置植入术的患者，他们在植入后 1 个月、6 个月和 12 个月时进行了连续胸部 X 光检查。我们测量了泵的角度、泵与脊柱的距离和泵与膈肌的深度，并通过复发性事件生存模型研究了它们与心力衰竭再入院、低流量警报、中风或流入/流出阻塞需要手术重新定位的复合结果之间的关系。
在 1 至 6 个月期间，绝对泵与脊柱的距离变化了 10.00mm（P<0.01），绝对泵与膈肌的深度变化了 18.80mm（P<0.01）。在植入后 6 至 12 个月期间，这些参数没有显著变化。泵的角度在任何时间段都没有明显变化。26 例患者出现了复合结果；在这些患者中，1 个月时的中位数泵角度为 66.2°（四分位间距 54.5-78.0），而 33 例没有不良事件的患者的中位数泵角度为 59.0°（四分位间距 47.0-65.0）（P=0.04）。1 个月时的泵深度和泵与脊柱的距离与复合结果无关。1 至 6 个月期间泵深度的变化（HR 1.019；95%置信区间 1.000-1.039）和 6 至 12 个月期间（HR 1.020；95%置信区间 1.000-1.040）与复合结果呈弱相关。
较大的泵角度与与位置相关的不良事件的复合结果相关。泵深度的变化与复合结果呈弱相关。
