From the Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
ASAIO J. 2021 Apr 1;67(4):423-429. doi: 10.1097/MAT.0000000000001248.
Significant residual mitral regurgitation (MR) after left ventricular assist device (LVAD) implantation has been associated with increased morbidity and mortality. The effect of cannula position on improvement of preexisting MR has yet to be evaluated. Consecutive patients who underwent centrifugal LVAD implantation with >mild preoperative MR and without concomitant mitral repair were reviewed. Left ventricular assist device position was determined by the angle between actual and ideal inflow cannula on computed tomography. The magnitudes of angles (anterior and lateral angle) were added to form an LVAD position assessment (LVADpa). Mitral regurgitation was numerically classified, and improvement in MR was determined by difference in MR preoperatively to MR >1 month postoperatively with a median of 162 (interquartile range: 78-218) days. The primary analysis examined the relationship between LVADpa and postoperative MR. Forty-one patients were identified with >mild preoperative functional MR. Mean age was 51 ± 13 years with an ejection fraction of 16 ± 4%. Overall, MR improved from moderate-severe preoperatively to mild postoperatively (p < 0.001). On multivariable analysis, higher LVADpa deviation was associated with greater postoperative MR (odds ratio [OR] = 2.29, p = 0.005) and higher 1-month pulsatility index was associated with lower postoperative MR (OR = 0.47, p = 0.011). Inflow cannula position during centrifugal LVAD implantation is an important determinant of postoperative MR.
左心室辅助装置（LVAD）植入后仍存在明显的二尖瓣反流（MR）与发病率和死亡率增加有关。目前尚未评估套管位置对改善原有 MR 的影响。回顾了连续接受离心式 LVAD 植入术且术前存在>轻度 MR 且无同时行二尖瓣修复的患者。LVAD 位置通过 CT 上实际和理想流入套管之间的角度确定。角度（前角和侧角）的大小相加形成 LVAD 位置评估（LVADpa）。MR 采用数值分类，并通过术前 MR 与术后>1 个月 MR 的差值来确定 MR 的改善，中位数为 162（四分位距：78-218）天。主要分析检查了 LVADpa 与术后 MR 之间的关系。确定了 41 例术前存在>轻度功能性 MR 的患者。平均年龄为 51±13 岁，射血分数为 16±4%。总体而言，MR 从术前中重度改善为术后轻度（p<0.001）。多变量分析显示，LVADpa 偏差越大，术后 MR 越严重（比值比[OR] = 2.29，p = 0.005），1 个月搏动指数越高，术后 MR 越低（OR = 0.47，p = 0.011）。离心式 LVAD 植入过程中的流入套管位置是术后 MR 的重要决定因素。
