From the Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
ASAIO J. 2023 Oct 1;69(10):907-914. doi: 10.1097/MAT.0000000000002010. Epub 2023 Sep 27.
Right ventricular (RV) dysfunction is common after left ventricular assist device (LVAD) implantation leading to clinical right heart failure (RHF) associated with worsened survival and quality of life. It is likely that intraoperative events such as anesthesia induction play a role in the development or unmasking of RV dysfunction in addition to known effects from hemodynamic changes that occur after LVAD implantation. The EACH-LVAD Study is a prospective, single-center, single-arm, observational cohort study of adult patients with advanced heart failure undergoing durable LVAD implantation with standard anesthesia induction. Intraoperative RV hemodynamics via central venous pressure, mean pulmonary artery pressure, pulmonary artery pulsatility index, and vasoactive-inotropic score (a simple weighted summation of standardized drug doses) and echocardiographic parameters (RV fractional area change, RV area in diastole, RV basal diameter, septum position, RV function, tricuspid regurgitation) were measured and compared at prespecified timepoints, including postinduction. Postoperative clinical RHF was determined based on published definitions. Forty-two patients receiving a first-time LVAD were included between September 2017 and March 2019. Propofol-based induction was used in 31 patients and etomidate-based induction in eight patients. A significant increase in central venous pressure (CVP; p < 0.001), mean pulmonary artery pressure (mPAP; p < 0.001), and vasoactive inotropic score (VIS; p < 0.001) with associated decrease in pulmonary artery pulsatility index (PAPi; p < 0.001) was observed. Right ventricular function worsened throughout. Right heart failure occurred in 70% of patients. Propofol-based induction was not associated with a higher risk of RHF (relative risk [RR], 1.01 [95% confidence interval {CI}, 0.64-1.61]). The EACH-LVAD study demonstrates an effect of anesthesia induction on worsened RV hemodynamics and echocardiographic changes which may have an effect on the development of RHF.
右心室（RV）功能障碍在左心室辅助装置（LVAD）植入后很常见，导致临床右心衰竭（RHF），并伴有生存和生活质量恶化。除了 LVAD 植入后发生的血流动力学变化的已知影响外，术中事件（如麻醉诱导）可能在 RV 功能障碍的发展或显现中起作用。EACH-LVAD 研究是一项前瞻性、单中心、单臂、观察性队列研究，纳入了接受耐用性 LVAD 植入的晚期心力衰竭成年患者，采用标准麻醉诱导。通过中心静脉压、平均肺动脉压、肺动脉搏动指数和血管活性-正性肌力评分（标准化药物剂量的简单加权总和）以及超声心动图参数（RV 分数面积变化、RV 舒张期面积、RV 基底直径、室间隔位置、RV 功能、三尖瓣反流）测量并比较了术中 RV 血液动力学，包括诱导后。根据已发表的定义确定术后临床 RHF。2017 年 9 月至 2019 年 3 月期间，共纳入 42 例首次接受 LVAD 的患者。31 例患者采用依托咪酯诱导，8 例患者采用丙泊酚诱导。中心静脉压（CVP；p < 0.001）、平均肺动脉压（mPAP；p < 0.001）和血管活性-正性肌力评分（VIS；p < 0.001）显著升高，同时肺动脉搏动指数（PAPi；p < 0.001）降低。整个过程中 RV 功能恶化。70%的患者发生 RHF。依托咪酯诱导与 RHF 风险增加无关（相对风险 [RR]，1.01 [95%置信区间 {CI}，0.64-1.61]）。EACH-LVAD 研究表明，麻醉诱导对 RV 血液动力学和超声心动图变化有影响，可能对 RHF 的发生有影响。
