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右心室微型轴流泵支持在心脏手术患者中的结果。

Outcome of right ventricular microaxial pump support in patients undergoing cardiac surgery.

机构信息

Department of Cardiovasular Surgery, University Hospital of Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.

Department of Cardiology and Rhythmology, Hospital Mechernich, Mechernich, Germany.

出版信息

Sci Rep. 2024 Apr 6;14(1):8078. doi: 10.1038/s41598-024-58602-w.

Abstract

Right ventricular failure (RVF) after cardiac surgery is associated with an in-hospital mortality rate of up to 75%. Microaxial flow pumps are one of the mechanical circulatory supports (MCS) options available for the treatment of RVF, however the specifics of timing and indication for MCS, as well as predictors for survival, remain unclear due to a dearth of published data. We evaluated the clinical outcome of patients treated with Impella-RP for predictors of mortality and the hemodynamic effects of the pump. This is a single-center retrospective observational study involving adult patients who underwent cardiac surgery with cardiopulmonary bypass between January 2019 and December 2020 in cardiac surgery and required therapeutic management of RVF with an Impella-RP. Overall, 18 patients were included and analyzed for factors that could be associated with mortality, or that could be predictors of patient outcomes for this population. Treatment of RVF with Impella-RP improved the patient hemodynamics significantly and had a survival rate of 61% within 30 days. Patients with isolated CABG or better liver function before implantation had a better survival rate, which may indicate that underlying disease and timing of implantation are significant for successful treatment of RVF.

摘要

右心衰竭(RVF)是心脏手术后的一种严重并发症,其院内死亡率高达 75%。微轴流泵是治疗 RVF 的机械循环支持(MCS)选择之一,但由于缺乏已发表的数据,MCS 的时机和适应证以及生存预测因素仍不清楚。我们评估了使用 Impella-RP 治疗的患者的临床结果,以预测死亡率和泵的血流动力学效应。这是一项单中心回顾性观察性研究,涉及 2019 年 1 月至 2020 年 12 月期间在心脏外科手术中接受体外循环心脏手术的成年患者,这些患者需要使用 Impella-RP 来治疗 RVF。总体而言,18 例患者被纳入并分析了可能与死亡率相关的因素,或可能是该人群患者预后的预测因素。使用 Impella-RP 治疗 RVF 可显著改善患者的血流动力学,30 天内的生存率为 61%。在植入前肝功能为 CABG 或更好的患者中,生存率更高,这可能表明基础疾病和植入时机对 RVF 的成功治疗至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5989/10997586/31c67a144d04/41598_2024_58602_Fig1_HTML.jpg

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