Riebandt Julia, Schaefer Anne, Wiedemann Dominik, Schlöglhofer Thomas, Laufer Günther, Sandner Sigrid, Zimpfer Daniel
Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
Ann Cardiothorac Surg. 2021 Mar;10(2):248-254. doi: 10.21037/acs-2020-cfmcs-30.
Additional cardiac pathologies including tricuspid or mitral valve regurgitation are common in left ventricular assist device (LVAD) recipients and whether to address them remains controversial. We present our institutional outcomes of concomitant cardiac procedures, other than temporary right ventricular (RV) support, at the time of LVAD implantation.
From 03/2006 to 06/2020, 352 adult patients {median age 60 [interquartile range (IQR): 52-66] years; INTERMACS level 1 29%; INTERMACS level 2 17%; INTERMACS level 3 23%, INTERMACS level 4-6 31%; male 86%} underwent continuous-flow LVAD [Medtronic HVAD (HVAD) 50%; Abbott HeartMate II (HMII) 17%; Abbott HeartMate 3 (HM3) 33%] implantation. Concomitant valvular procedures were performed in 86 patients (24%) and the majority of patients received the LVAD as bridge to candidacy (BTC) for transplant (74%). Primary study endpoints were short- and mid-term mortality, as well as need for temporary RV support.
Tricuspid valve annuloplasty was the most frequent concomitant procedure (77%), followed by aortic valve replacements (AVRs) or Park's stitch (33%). Temporary RV support was common in the study cohort (35%) using either extracorporeal life support (ECLS, 37%) or a temporary RV assist device (RVAD, 63%). A less invasive (LIS) implantation technique was pursued in 12%. Thirty-day mortality was comparable between those with and without concomitant surgery (4% 6%, P=0.426). In-hospital mortality was significantly higher for additional interventions (22% 14%, P=0.05), whereas one-year survival was similar (71% 79%, P=0.106).
Concomitant cardiac procedures, especially tricuspid and aortic valve surgery, are frequent but are associated with a higher perioperative morbidity and mortality.
包括三尖瓣或二尖瓣反流在内的其他心脏病变在左心室辅助装置（LVAD）植入受者中很常见，是否处理这些病变仍存在争议。我们展示了我们机构在LVAD植入时进行的除临时右心室（RV）支持之外的同期心脏手术的结果。
从2006年3月至2020年6月，352例成年患者{中位年龄60岁[四分位间距（IQR）：52 - 66岁]；INTERMACS 1级29%；INTERMACS 2级17%；INTERMACS 3级23%，INTERMACS 4 - 6级31%；男性86%}接受了连续流LVAD植入[美敦力HVAD（HVAD）50%；雅培HeartMate II（HMII）17%；雅培HeartMate 3（HM3）33%]。86例患者（24%）进行了同期瓣膜手术，大多数患者接受LVAD作为移植候选桥接（BTC，74%）。主要研究终点为短期和中期死亡率，以及是否需要临时RV支持。
三尖瓣环成形术是最常见的同期手术（77%），其次是主动脉瓣置换术（AVR）或帕克缝合法（33%）。在研究队列中，临时RV支持很常见（35%），使用体外生命支持（ECLS，37%）或临时RV辅助装置（RVAD，63%）。12%的患者采用了侵入性较小的（LIS）植入技术。有或没有同期手术的患者30天死亡率相当（4%对6%，P = 0.426）。额外干预的住院死亡率显著更高（22%对14%，P = 0.05），而1年生存率相似（71%对79%，P = 0.106）。
同期心脏手术，尤其是三尖瓣和主动脉瓣手术很常见，但与围手术期更高的发病率和死亡率相关。
