Mirza Arslan, Romero Carlos Manuel, Toyoda Yoshiya, Hamad Eman A
Temple Heart and Vascular Institute, Temple University Hospital, Philadelphia, PA.
Department of Internal Medicine, Temple University Hospital, Philadelphia, PA.
Ochsner J. 2021 Winter;21(4):341-346. doi: 10.31486/toj.20.0160.
Few patients with a left ventricular assist device (LVAD) achieve functional myocardial recovery to the point of LVAD explantation. The aim of this study was to highlight some of the hemodynamic and echocardiographic parameters we observed in patients who recovered. We conducted a retrospective analysis of 7 patients who received the HeartMate II LVAD (Abbott) at Temple Heart and Vascular Institute and subsequently underwent successful explantation following myocardial recovery. We compared baseline characteristics, echocardiographic data, and hemodynamic data. Baseline characteristics of the cohort were as follows: age 51.6 ± 12.0 years, 57.1% male, 42.9% with nonischemic cardiomyopathy, and mean duration of LVAD support of 10.6 months. Comparison of echocardiographic and hemodynamic data (preimplant vs preexplant) revealed the following: left ventricular ejection fraction (%) was 12.8 ± 6.9 vs 52.8 ± 8.1 (=0.0001), right atrial pressure (mmHg) was 12.3 ± 3.4 vs 5.0 ± 4.0 (=0.022), mean pulmonary artery pressure (mmHg) was 36.0 ± 7.8 vs 15.4 ± 7.1 (=0.01), cardiac output (L/min) was 3.6 ± 1.3 vs 5.5 ± 1.8 (=0.004), and cardiac index (L/min/m) was 1.8 ± 0.5 vs 2.7 ± 0.7 (=0.008). Mean LVAD-free survival was 49.1 months. Results were consistent in both ischemic and nonischemic LVAD explants. A potential for LVAD explantation exists in patients with both ischemic and nonischemic cardiomyopathy. Myocardial recovery may be more likely among young patients with nonischemic cardiomyopathy and patients with recently diagnosed ischemic cardiomyopathy. Future prospective studies are needed.
很少有左心室辅助装置（LVAD）患者能实现功能性心肌恢复到可以移除LVAD的程度。本研究的目的是强调我们在恢复的患者中观察到的一些血流动力学和超声心动图参数。我们对7例在坦普尔心脏和血管研究所接受HeartMate II LVAD（雅培公司）并随后在心肌恢复后成功移除装置的患者进行了回顾性分析。我们比较了基线特征、超声心动图数据和血流动力学数据。该队列的基线特征如下：年龄51.6±12.0岁，男性占57.1%，42.9%患有非缺血性心肌病，LVAD支持的平均持续时间为10.6个月。超声心动图和血流动力学数据（植入前与移除前）的比较显示如下：左心室射血分数（%）为12.8±6.9对比52.8±8.1（P = 0.0001），右心房压力（mmHg）为12.3±3.4对比5.0±4.0（P = 0.022），平均肺动脉压力（mmHg）为36.0±7.8对比15.4±7.1（P = 0.01），心输出量（L/分钟）为3.6±1.3对比5.5±1.8（P = 0.004），心脏指数（L/分钟/平方米）为1.8±0.5对比2.7±0.7（P = 0.008）。平均无LVAD生存期为49.1个月。缺血性和非缺血性LVAD移除患者的结果一致。缺血性和非缺血性心肌病患者都存在移除LVAD的可能性。非缺血性心肌病的年轻患者和近期诊断为缺血性心肌病的患者心肌恢复的可能性可能更大。未来需要进行前瞻性研究。
