Division of Cardiovascular Medicine, Stanford University, Palo Alto, California.
Division of Cardiology, New York-Presbyterian, Columbia University Medical Center, New York, New York.
Ann Thorac Surg. 2023 May;115(5):1282-1288. doi: 10.1016/j.athoracsur.2021.12.014. Epub 2022 Jan 6.
In patients with the HeartMate 3 (HM3, Abbott) left ventricular (LV) assist device (LVAD), outflow graft narrowing has been reported as a result of accumulation of biodebris either internal or external to the graft. This study describes the prevalence, imaging findings, and clinical outcomes associated with HM3 LVAD outflow graft narrowing.
A single-center retrospective cohort study was performed in patients who received an HM3 LVAD between November 2014 and July 2019. All patients with a computed tomographic (CT) angiogram or a CT scan with intravenous contrast sufficient to evaluate the outflow graft lumen were included. Narrowing was defined as a hypodensity of ≥3 mm.
Of 165 HM3 LVAD recipients, 46 (28%) had qualifying imaging. Outflow graft narrowing was present in 33% (15/46). One patient had complete obstruction requiring emergency surgery, whereas 14 patients had a median hypodensity of 4.5 mm (interquartile range, 3.3-5.8 mm). The presence of outflow graft narrowing was significantly associated with a longer duration of LVAD support (588.2 ± 277.5 days vs 131.5 ± 170.9 days; P < .0001). One-year survival after identification of narrowing was 93%, with death occurring in 1 patient with complete obstruction. LV unloading (mean percent decrease in LV end-diastolic diameter at time of CT imaging vs pre-LVAD) was 16.7% vs 17.7% in patients with and without narrowing, respectively (P = .86).
Among patients with adequate imaging, one-third have evidence of narrowing. Outflow graft narrowing secondary to biodebris was more likely to be found in HM3 LVAD recipients with longer duration of LVAD support. There was no significant difference in LV unloading between patients with and without narrowing.
在接受 HeartMate 3（HM3，雅培）左心室（LV）辅助装置（LVAD）的患者中，已报道由于移植物内外生物碎屑的积累导致流出移植物变窄。本研究描述了 HM3 LVAD 流出移植物狭窄的发生率、影像学表现和临床结局。
对 2014 年 11 月至 2019 年 7 月期间接受 HM3 LVAD 的患者进行了单中心回顾性队列研究。所有接受 CT 血管造影或静脉内对比 CT 扫描以充分评估流出移植物管腔的患者均被纳入。狭窄定义为≥3mm 的低信号强度。
在 165 例 HM3 LVAD 受者中，有 46 例（28%）有合格的影像学检查。33%（15/46）的患者存在流出移植物狭窄。1 例患者完全梗阻需要紧急手术，而 14 例患者的平均低信号强度为 4.5mm（四分位距，3.3-5.8mm）。流出移植物狭窄的存在与更长的 LVAD 支持时间显著相关（588.2±277.5 天与 131.5±170.9 天；P<0.0001）。识别出狭窄后 1 年的生存率为 93%，1 例完全梗阻患者死亡。LV 卸载（CT 成像时 LV 舒张末期直径的平均百分比减少与 LVAD 前）分别为狭窄组的 16.7%和无狭窄组的 17.7%（P=0.86）。
在有足够影像学检查的患者中，有三分之一的患者有狭窄的证据。由于生物碎屑引起的流出移植物狭窄更可能发生在 LVAD 支持时间较长的 HM3 LVAD 受者中。在有和没有狭窄的患者之间，LV 卸载没有显著差异。
