Mandarino W A, Winowich S, Gasior T A, Pham S, Griffith B P, Kormos R L
Division of Cardiothoracic Surgery, University of Pittsburgh, PA, USA.
ASAIO J. 1997 Sep-Oct;43(5):M801-5.
Right ventricular assist devices (RVAD) are often needed on a short term basis in patients who develop RV failure after left ventricular assist device (LVAD) implantation. The purpose of this study was to use LVAD filling characteristics to help determine the timing for weaning a patient from RVAD support. Eleven patients (age 50 years +/- 15) supported with an LVAD (Novacor) and an RVAD (Biomedicus or ABIOMED) were studied. Eight patients (RV recovery group) were studied before RVAD removal and all were successfully weaned from RVAD support. Five patients (RV failure group) were studied at the time of RVAD placement to determine baseline characteristics of RV failure. Simultaneous measures of LVAD volume and routine hemodynamics were recorded during periods of high and low RVAD flow. The LVAD filling was assessed as the first derivative of LVAD volume and the mean filling rate for each cardiac cycle was calculated and averaged over 10 sec periods at both RVAD flows. The mean pump rate corrected filling rates did not change in the RV recovery group (89 +/- 13 vs. 87 +/- 8 ml/beat) and significantly decreased in the RV failure group (84 +/- 19 vs. 62 +/- 22 ml/ beat) (p < 0.001) with decreasing RVAD flow. These data suggest that LVAD filling rates may be used to assess RV systolic function and the proper timing of RVAD removal in selected patients.
对于在植入左心室辅助装置（LVAD）后出现右心室衰竭的患者，通常需要短期使用右心室辅助装置（RVAD）。本研究的目的是利用LVAD的充盈特征来帮助确定患者撤离RVAD支持的时机。对11例接受LVAD（Novacor）和RVAD（Biomedicus或ABIOMED）支持的患者（年龄50岁±15岁）进行了研究。对8例患者（右心室恢复组）在移除RVAD之前进行了研究，所有患者均成功撤离RVAD支持。对5例患者（右心室衰竭组）在放置RVAD时进行了研究，以确定右心室衰竭的基线特征。在RVAD高流量和低流量期间记录LVAD容积和常规血流动力学的同步测量值。将LVAD充盈评估为LVAD容积的一阶导数，并计算每个心动周期的平均充盈率，并在两种RVAD流量下的10秒时间段内进行平均。随着RVAD流量降低，右心室恢复组的平均泵速校正充盈率没有变化（89±13 vs. 87±8 ml/次搏动），而右心室衰竭组显著降低（84±19 vs. 62±22 ml/次搏动）（p<0.001）。这些数据表明，LVAD充盈率可用于评估右心室收缩功能以及选定患者中RVAD移除的合适时机。
