Department of Cardiac Surgery, Medstar Washington Hospital Center, Washington, DC, USA.
Georgetown University School of Medicine, Washington, DC, USA.
Eur J Cardiothorac Surg. 2022 Jun 15;62(1). doi: 10.1093/ejcts/ezab480.
The influence of preoperative left ventricular size in outcomes following centrifugal-flow left ventricular assist device (LVAD) implantation has not been well characterized.
A cohort of 313 patients who received a centrifugal-flow LVAD at a single institution was analysed. Using a maximally selected log-rank statistic, we investigated whether a left ventricular end-diastolic dimension (LVEDD) cut-off point was associated with worse outcomes. The cohort was then divided in 2 groups based on the LVEDD cut-off point.
An LVEDD cut-off point of 59 mm was found to predict worse survival. Smaller LVEDD patients (≤59 mm, N = 52) were older and more likely to have a history of coronary artery disease compared those with a larger LVEDD (>59 mm, N = 261). Smaller LVEDD patients had lower survival compared to larger LVEDD patients (71% vs 85% at 1 year and 58% vs 80% at 2 years, P = 0.003). The need for temporary right ventricular mechanical support was significantly higher in the smaller LVEDD cohort (11.5% vs 1.9%, P = 0.002). Pump flows at time of discharge were lower in the smaller LVEDD group (3.8 vs 4.2 l/min, P = 0.005), who also had a higher incidence of late right ventricular failure (23% vs 12%, P = 0.02), higher rates of gastrointestinal bleeding (0.416 vs 0.256 events per patient-year, P = 0.025) and higher readmissions secondary to low flow alarms (0.429 vs 0.240 events per patient-year, P = 0.007). Multivariable analysis demonstrated that smaller LVEDD, older age, high BUN and high bilirubin levels were independent predictors of worse survival.
In patients receiving a centrifugal-flow LVAD, smaller preoperative LVEDD (≤59 mm) was associated with lower survival and higher incidence of adverse outcomes.
术前左心室大小对离心流左心室辅助装置（LVAD）植入术后结果的影响尚未得到很好的描述。
对在一家机构接受离心流 LVAD 的 313 例患者进行了分析。使用最大选择对数秩检验，我们研究了左心室舒张末期内径（LVEDD）截断值是否与较差的结果相关。然后根据 LVEDD 截断值将队列分为两组。
发现 LVEDD 截断值为 59mm 可预测生存率较差。较小的 LVEDD 患者（≤59mm，N=52）年龄较大，且更有可能患有冠状动脉疾病史，而较大的 LVEDD 患者（>59mm，N=261）则较少。较小的 LVEDD 患者的生存率明显低于较大的 LVEDD 患者（1 年时为 71%对 85%，2 年时为 58%对 80%，P=0.003）。较小的 LVEDD 组中需要临时右心室机械支持的患者明显更多（11.5%对 1.9%，P=0.002）。较小的 LVEDD 组在出院时的泵流量较低（3.8 对 4.2L/min，P=0.005），且晚期右心室衰竭的发生率较高（23%对 12%，P=0.02），胃肠道出血的发生率也较高（0.416 对 0.256 个患者/年，P=0.025），因低流量报警导致的再次入院率也较高（0.429 对 0.240 个患者/年，P=0.007）。多变量分析表明，较小的 LVEDD、年龄较大、BUN 和胆红素水平较高是生存率较差的独立预测因素。
在接受离心流 LVAD 的患者中，术前较小的 LVEDD（≤59mm）与生存率较低和不良结局发生率较高相关。
