Clinic for Thoracic and Cardiovascular Surgery, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
Heart Failure Department, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bochum, Bad Oeynhausen, Germany.
J Cardiovasc Transl Res. 2022 Jun;15(3):676-686. doi: 10.1007/s12265-021-10178-w. Epub 2021 Oct 28.
The interactions and hemodynamic impact of transcatheter percutaneous mitral valve repair (TMR) have not yet been investigated in patients undergoing left ventricular assist device (LVAD) implantation, but hemodynamic adverse effects are feared in the combination of TMR and LVAD for altered mitral valve flow. This study investigated the hemodynamic interplay in combination of TMR and LVAD in 119 patients, and propensity score match analysis revealed no difference in both perioperative mortality and 2-year follow-up survival (p = 0.84). Nonetheless, postoperatively mean pulmonary arterial pressure, pulmonary capillary wedge pressure, and cardiac index improved, and multivariable cox regression analysis at 2 years identified preoperative total bilirubin and temporary right ventricular mechanical circulatory support as independent risk factors for all-cause mortality but not TMR. Prior TMR has no impact on mortality or cardiovascular complications in patients with LVAD.
经导管二尖瓣修复术（TMR）与左心室辅助装置（LVAD）植入术同时进行时，其相互作用和血液动力学影响尚未得到研究，但二尖瓣血流改变时 TMR 和 LVAD 联合应用可能会产生血液动力学不良影响。本研究调查了 119 例 TMR 和 LVAD 联合应用的血液动力学相互作用，倾向性评分匹配分析显示，围手术期死亡率和 2 年随访生存率均无差异（p=0.84）。然而，术后平均肺动脉压、肺毛细血管楔压和心指数均有所改善，2 年时多变量 Cox 回归分析确定术前总胆红素和临时右心室机械循环支持是全因死亡率的独立危险因素，但不是 TMR 的独立危险因素。LVAD 患者中，既往 TMR 对死亡率或心血管并发症无影响。
