Farrar D J, Hill J D, Pennington D G, McBride L R, Holman W L, Kormos R L, Esmore D, Gray L A, Seifert P E, Schoettle G P, Moore C H, Hendry P J, Bhayana J N
California Pacific Medical Center, San Francisco 94115, USA.
J Thorac Cardiovasc Surg. 1997 Jan;113(1):202-9. doi: 10.1016/S0022-5223(97)70416-1.
The goal of this study was to determine whether there are differences in populations of patients with heart failure who require univentricular or biventricular circulatory support.
Two hundred thirteen patients who were in imminent risk of dying before donor heart procurement and who received Thoratec left (LVAD) and right (RVAD) ventricular assist devices at 35 hospitals were divided into three groups: group 1 (n = 74), patients adequately supported with isolated LVADs; group 2 (n = 37), patients initially receiving an LVAD and later requiring an RVAD; and group 3 (n = 102), patients who received biventricular assistance (BiVAD) from the beginning.
There were no significant differences in any preoperative factors between the two BiVAD groups. In the combined BiVAD groups, pre-VAD cardiac index (BiVAD, 1.4 +/- 0.6 L/min per square meter, vs LVAD, 1.6 +/- 0.6 L/min per square meter) and pulmonary capillary wedge pressure (BiVAD, 27 +/- 8 mm Hg, vs LVAD, 30 +/- 8 mm Hg) were significantly lower than those in the LVAD group, and pre-VAD creatinine levels were significantly higher (BiVAD, 1.9 +/- 1.1 mg/dl, vs LVAD, 1.4 +/- 0.6 mg/dl). In addition, greater proportions of patients in the BiVAD groups required mechanical ventilation before VAD placement (60% vs 35%) and were implanted under emergency conditions than in the LVAD group (22% vs 9%). The survival of patients through heart transplantation was significantly better in patients who had an LVAD (74%) than in those who had BiVADs (58%). However, there were no significant differences in posttransplantation survival through hospital discharge (LVAD, 89%; BiVAD, 81%).
Patients who received LVADs were less severely ill before the operation and consequently were more likely to survive after the operation. As the severity of illness increases, patients are more likely to require biventricular support.
本研究的目的是确定需要单心室或双心室循环支持的心力衰竭患者群体之间是否存在差异。
213例在获取供体心脏前濒死且在35家医院接受Thoratec左心室辅助装置（LVAD）和右心室辅助装置（RVAD）的患者被分为三组：第1组（n = 74），仅使用LVAD充分支持的患者；第2组（n = 37），最初接受LVAD且后来需要RVAD的患者；第3组（n = 102），从一开始就接受双心室辅助（BiVAD）的患者。
两个BiVAD组之间的任何术前因素均无显著差异。在联合BiVAD组中，VAD植入前心脏指数（BiVAD为1.4±0.6 L/分钟每平方米，LVAD为1.6±0.6 L/分钟每平方米）和肺毛细血管楔压（BiVAD为27±8 mmHg，LVAD为30±8 mmHg）显著低于LVAD组，且VAD植入前肌酐水平显著更高（BiVAD为1.9±1.1 mg/dl，LVAD为1.4±0.6 mg/dl）。此外，BiVAD组中在VAD植入前需要机械通气的患者比例更高（60%对35%），且在紧急情况下植入的患者比例高于LVAD组（22%对9%）。接受LVAD的患者通过心脏移植的生存率（74%）显著高于接受BiVAD的患者（58%）。然而，至出院时的移植后生存率无显著差异（LVAD为89%；BiVAD为81%）。
接受LVAD的患者术前病情较轻，因此术后更有可能存活。随着病情严重程度增加，患者更有可能需要双心室支持。
