Hironaka Camille E, Ortoleva Jamel, Zhan Yong, Chen Frederick Y, Couper Gregory S, Kapur Navin K, Kawabori Masashi
From the Tufts Medical School, Boston, Massachusetts.
Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts.
ASAIO J. 2022 Apr 1;68(4):541-546. doi: 10.1097/MAT.0000000000001529.
Impella left ventricular assist devices (LVADs) (Abiomed, Danvers, MA) are implanted in the left ventricle across the aortic valve. Several cases of secondary aortic insufficiency (AI) or mitral regurgitation (MR) after Impella LVAD use have been reported. Secondary valvulopathies can worsen cardiac function. This single center retrospective study sought to characterize the incidence of secondary AI and MR development after Impella LVAD support. One hundred fifty-two patients who underwent Impella LVAD support between April 2014 and August 2019 were included. Patient demographics, implant indications, duration of support, pre- and post-Impella LVAD echocardiograms, and incidence of increased AI/MR were analyzed. Impella 5.0 and Impella CP were subanalyzed. Following exclusion criteria, AI and MR were analyzed in 93 and 78 patients, respectively. An increase in AI and MR was seen in 17.2% and 12.8% of patients with an event per support days of 0.03 and 0.02, respectively. Clinically significant increases in AI and MR were seen in 3.2% (n = 3), 6.4% (n = 5), respectively. The incidences of increased AI (p = 0.33) and MR (p = 0.45) were similar between Impella 5.0 and Impella CP patients. Worsening AI and MR clinically occur at a low incidence with Impella LVAD use. However, careful follow-up is still warranted.
Impella左心室辅助装置（LVADs）（Abiomed公司，马萨诸塞州丹弗斯）经主动脉瓣植入左心室。已有数例使用Impella LVAD后出现继发性主动脉瓣关闭不全（AI）或二尖瓣反流（MR）的病例报道。继发性瓣膜病变会使心功能恶化。这项单中心回顾性研究旨在明确Impella LVAD支持后继发性AI和MR发生的发生率。纳入了2014年4月至2019年8月期间接受Impella LVAD支持的152例患者。分析了患者的人口统计学资料、植入指征、支持时间、Impella LVAD植入前后的超声心动图以及AI/MR加重的发生率。对Impella 5.0和Impella CP进行了亚组分析。根据排除标准，分别对93例和78例患者的AI和MR进行了分析。AI和MR加重分别见于17.2%和12.8%的患者，每支持日事件发生率分别为0.03和0.02。临床上AI和MR显著加重分别见于3.2%（n = 3）和6.4%（n = 5）的患者。Impella 5.0和Impella CP患者之间AI加重（p = 0.33）和MR加重（p = 0.45）的发生率相似。使用Impella LVAD时，临床上AI和MR恶化的发生率较低。然而，仍需仔细随访。
