Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
J Artif Organs. 2022 Sep;25(3):204-213. doi: 10.1007/s10047-021-01302-3. Epub 2021 Nov 26.
The hemodynamic and exercise capacity performance of the Jarvik 2000 left ventricular assist device (LVAD), which is generally used in patients with small body size and relatively preserved cardiac function, is not well understood. We retrospectively examined 18 patients implanted with the Jarvik 2000 LVAD. Pump rotation speed was optimized by the hemodynamic ramp test one year after implantation based on the criteria of mean pulmonary capillary wedge pressure (PCWP) < 18 mmHg, mean right atrial pressure (RAP) < 12 mmHg, and cardiac index (CI) > 2.2 L/min/m as well as echocardiographic parameters. Exercise capacity was assessed by cardiopulmonary exercise test in an optimized setting. To investigate the impacts of larger body surface area (BSA) and extremely impaired pre-implantation cardiac function on hemodynamics and exercise capacity, two correlation analyses based on BSA and original CI were performed. At a pump speed of 9500 ± 707 rpm, the mean pulmonary artery pressure, PCWP, RAP, and CI were 17 ± 5 mmHg, 9 ± 5 mmHg, 6 ± 4 mmHg, and 2.82 ± 0.54 L/min/m, respectively. Only one patient failed to achieve the hemodynamic criteria. The peak VO and VE/VCO slope were 12.9 ± 3.1 mL/min/kg and 37.7 ± 15.0, respectively. There was an inverse correlation between original CI and heart rate (r = -0.60, p = 0.01), and a weak correlation between BSA and PCWP (r = 0.43, p = 0.08). Based on this study, the overall performance of the Jarvik 2000 device was acceptable, and the patients' body size and original cardiac function had minimum effect on the performance of this device.
我们回顾性分析了 18 例行 Jarvik 2000 左心室辅助装置（LVAD）植入的患者。在植入后 1 年，通过血流动力学斜坡试验，根据平均肺动脉压（mPAP）<18mmHg、平均右心房压（RAP）<12mmHg、心指数（CI）>2.2L/min/m2 以及超声心动图参数，优化泵的旋转速度。在优化的条件下，通过心肺运动试验评估运动能力。为了研究更大的体表面积（BSA）和植入前心脏功能严重受损对血流动力学和运动能力的影响，我们进行了两项基于 BSA 和原始 CI 的相关性分析。在 9500±707rpm 的泵速下，平均肺动脉压、PCWP、RAP 和 CI 分别为 17±5mmHg、9±5mmHg、6±4mmHg 和 2.82±0.54L/min/m。只有 1 名患者未能达到血流动力学标准。峰值 VO 和 VE/VCO 斜率分别为 12.9±3.1mL/min/kg 和 37.7±15.0。原始 CI 与心率呈负相关（r=-0.60，p=0.01），BSA 与 PCWP 呈弱相关（r=0.43，p=0.08）。基于这项研究，Jarvik 2000 装置的整体性能是可以接受的，患者的体型和原始心脏功能对该装置的性能影响最小。
