Zijderhand Casper F, Yalcin Yunus C, Sjatskig Jelena, Bos Daniel, Constantinescu Alina A, Manintveld Olivier C, Birim Ozcan, Bekkers Jos A, Bogers Ad J J C, Caliskan Kadir
Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
Rev Cardiovasc Med. 2023 Nov 9;24(11):313. doi: 10.31083/j.rcm2411313. eCollection 2023 Nov.
Right ventricular failure (RVF) is a significant cause of morbidity and mortality in patients with a left ventricular assist device (LVAD). This study is aimed to investigate the influence of a pectus excavatum on early and late outcomes, specifically RVF, following LVAD implantation.
A retrospective study was performed, that included patients with a HeartMate 3 LVAD at our tertiary referral center. The Haller index (HI) was calculated using computed tomography (CT) scan to evaluate the chest-wall dimensions.
In total, 80 patients (median age 57 years) were included. Two cohorts were identified: 28 patients (35%) with a normal chest wall (HI 2.0) and 52 patients (65%) with pectus excavatum (HI 2.0-3.2), with a mean follow-up time of 28 months. Early ( 30 days) RVF and early acute kidney injury events did not differ between cohorts. Overall survival did not differ between cohorts with a hazard ratio (HR) of 0.47 (95% confidence interval (CI): 0.19-1.19, = 0.113). Late ( 30 days) recurrent readmission for RVF occurred more often in patients with pectus excavatum ( = 0.008). The onset of late RVF started around 18 months after implantation and increased thereafter in the overall study cohort.
Pectus excavatum is observed frequently in patients with a LVAD implantation. These patients have an increased rate of readmissions and late RVF. Further investigation is required to explore the extent and severity of chest-wall abnormalities on the risk of RVF.
右心室衰竭（RVF）是左心室辅助装置（LVAD）患者发病和死亡的重要原因。本研究旨在探讨漏斗胸对LVAD植入术后早期和晚期结局，特别是RVF的影响。
进行了一项回顾性研究，纳入了我们三级转诊中心接受HeartMate 3 LVAD治疗的患者。使用计算机断层扫描（CT）扫描计算哈勒指数（HI），以评估胸壁尺寸。
共纳入80例患者（中位年龄57岁）。确定了两个队列：28例（35%）胸壁正常（HI<2.0）的患者和52例（65%）有漏斗胸（HI 2.0 - 3.2）的患者，平均随访时间为28个月。各队列之间早期（≤30天）RVF和早期急性肾损伤事件无差异。各队列之间的总生存率无差异，风险比（HR）为0.47（95%置信区间（CI）：0.19 - 1.19，P = 0.113）。漏斗胸患者晚期（>30天）因RVF再次入院的情况更常见（P = 0.008）。晚期RVF在植入后约18个月开始出现，并在整个研究队列中此后增加。
在接受LVAD植入的患者中经常观察到漏斗胸。这些患者再次入院率和晚期RVF发生率增加。需要进一步研究以探讨胸壁异常对RVF风险的影响程度和严重程度。
