Gomez Hamacher Claudio J R, Torregroza Carolin, Sadat Najla, Scheiber Daniel, von der Beek Jil-Cathrin, Westenfeld Ralf, Knorr Ivonne Jeanette, Sager Martin, Lichtenberg Artur, Saeed Diyar
Department of Cardiovascular Surgery, University Hospital, Heinrich-Heine University, Dusseldorf, Germany.
Department of Anesthesiology, University Hospital, Heinrich-Heine University, Dusseldorf, Germany.
JTCVS Open. 2020 Sep 24;4:16-23. doi: 10.1016/j.xjon.2020.09.001. eCollection 2020 Dec.
To evaluate the impact of severe tricuspid valve insufficiency (TVI) at the time of left ventricular assist device (LVAD) implantation on the hemodynamic and LVAD parameters in an acute ovine model.
Stable heart failure (HF) was induced in 10 ovines through the application of 3 ± 1 coronary ligations. Once stable HF was obtained (after 15 ± 5 days), the animals were supported with an LVAD. Hemodynamic data and pump parameters were obtained and compared in 2 settings; first with LVAD in place after weaning from the cardiopulmonary bypass machine (no TVI condition) and second following the induction of severe TVI through resection of the tricuspid valve (TVI condition).
There were no statistically significant differences in the hemodynamic and pump parameters between TVI condition and no TVI conditions except for lower cardiac output in the TVI condition (2 [1.38-2.8] L/min vs 3.2 [1.55-3.7] L/min, = .027) and the expected greater central venous pressure in the TVI condition (26 [24-31] mm Hg vs 15 [13-25] mm Hg, = .020). A median pump flow of 2.8 (2.45-3.75) L/min versus 2.9 (2.75-3.8) L/min in the TVI condition and no TVI condition was documented ( = .160).
Results from this acute animal study suggest that severe TVI in HF with preserved right ventricular function does not have significant impact on the LVAD pump parameters. The observed reduction in cardiac output may warrant further investigations, especially under loading conditions.
在急性绵羊模型中评估左心室辅助装置（LVAD）植入时严重三尖瓣关闭不全（TVI）对血流动力学和LVAD参数的影响。
通过进行3±1处冠状动脉结扎，在10只绵羊中诱导出稳定的心力衰竭（HF）。一旦获得稳定的HF（15±5天后），用LVAD支持这些动物。在两种情况下获取并比较血流动力学数据和泵参数；第一种情况是在从体外循环机撤机后LVAD就位（无TVI情况），第二种情况是在通过切除三尖瓣诱导出严重TVI后（TVI情况）。
除了TVI情况下心输出量较低（2[1.38 - 2.8]L/分钟对3.2[1.55 - 3.7]L/分钟，P = 0.027）以及TVI情况下中心静脉压预期更高（26[24 - 31]mmHg对15[13 - 25]mmHg，P = 0.020）外，TVI情况和无TVI情况之间的血流动力学和泵参数没有统计学上的显著差异。记录到TVI情况和无TVI情况下泵的中位流量分别为2.8（2.45 - 3.75）L/分钟对2.9（2.75 - 3.8）L/分钟（P = 0.160）。
这项急性动物研究的结果表明，右心室功能保留的HF中的严重TVI对LVAD泵参数没有显著影响。观察到的心输出量降低可能需要进一步研究，尤其是在负荷条件下。
