左心室辅助装置植入术前功能性二尖瓣反流的预后影响。
Prognostic impact of functional mitral regurgitation prior to left ventricular assist device implantation.
机构信息
Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20251, Hamburg, Germany.
出版信息
J Cardiothorac Surg. 2022 Feb 25;17(1):24. doi: 10.1186/s13019-021-01748-9.
BACKGROUND
Functional mitral regurgitation (FMR) is a common finding of advanced heart failure with detrimental effects. The prognostic impact of uncorrected FMR prior to left ventricular assist device (LVAD) implantation remains controversial.
METHODS
Between 2016 and 2019 77 patients underwent continuous-flow LVAD implantation at our institution. 34 patients showed FMR ≥ 2 (MR-group), whereas 43 patients showed FMR < 2 (Control-group). Data was retrospectively analyzed. Primary composite endpoint comprised freedom from death, stroke, pump-thrombosis, major bleeding and right heart failure (RHF) after 1 year.
RESULTS
Baseline characteristics, including the severity of left and right ventricular dysfunction, and periprocedural results were comparable. The overall survival during a mean follow up of 24.9 months was 55.9% in the MR-group versus 58.1% in the Control-group (p = 0.963), whereas 1-year event-free survival was 35.3% in the MR-group compared to 44.2% in the Control-group (p = 0.404). RHF within the first postoperative year occurred more frequently in the MR-group (35.3% vs. 11.6%; p = 0.017). Furthermore, RV function was significantly reduced in comparison to baseline values in the MR-group. 12 months after surgery, 74% of patients in the MR-group were classified as NYHA III in comparison to 24% of patients in the Control-group (p < 0.001).
CONCLUSIONS
Preoperative uncorrected FMR prior to LVAD implantation did not affect overall survival, nevertheless it was associated with an impaired RV function and increased incidence of right heart failure during follow-up. Furthermore, preoperative FMR ≥ 2 was associated with persistent symptoms of heart failure.
背景
功能性二尖瓣反流（FMR）是心力衰竭晚期的常见表现，具有不良影响。在植入左心室辅助装置（LVAD）之前，未经矫正的 FMR 对预后的影响仍存在争议。
方法
在我们机构，2016 年至 2019 年间，77 例患者接受了连续血流 LVAD 植入术。34 例患者出现 FMR≥2（MR 组），而 43 例患者出现 FMR<2（对照组）。对数据进行回顾性分析。主要复合终点包括植入后 1 年内死亡、卒中、泵血栓形成、大出血和右心衰竭（RHF）的无事件生存。
结果
在平均 24.9 个月的随访中，MR 组的总生存率为 55.9%，对照组为 58.1%（p=0.963），而 MR 组的 1 年无事件生存率为 35.3%，对照组为 44.2%（p=0.404）。在术后 1 年内，MR 组发生 RHF 的比例较高（35.3% vs. 11.6%；p=0.017）。此外，MR 组 RV 功能与基线相比显著下降。术后 12 个月，MR 组 74%的患者被归类为 NYHA III 级，而对照组为 24%（p<0.001）。
结论
在植入 LVAD 之前，未经矫正的 FMR 并不影响总生存率，但与 RV 功能受损和随访期间右心衰竭发生率增加有关。此外，术前 FMR≥2 与持续存在的心力衰竭症状相关。
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