Short-term mechanical circulatory support for recovery from acute right ventricular failure: Clinical outcomes
Short-term mechanical circulatory support for recovery from acute right ventricular failure: Clinical outcomes
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DOI：
10.1016/j.healun.2014.02.028
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发表时间：
2014-08-01
影响因子：
8.9
通讯作者：
Freed, Darren H.
中科院分区：
文献类型：
--
作者：
Cheung, Anson W.;White, Christopher W.;Freed, Darren H.
背景：急性右室衰竭(ARVF)难以得到最佳治疗，可能需要机械循环支持(MCS)的抢救治疗。与左心室相比，RV表现出更大的快速恢复能力，这使得专门为临时RV MCS设计的设备具有吸引力。我们报告了我们在ARVF患者中使用Impella Right Direct(RD)和Right Periphery(RP)临时辅助装置(Abied，Danver，MA)的经验。方法：我们进行了一项回顾性队列研究，考察了6年期间在两个机构连续接受Impella RD或RP支持的患者的临床结果。结果：在研究期间，18名患者(67%的男性；平均年龄57±10岁)接受了MCS，15名接受Impella RD或RP的患者，3名接受Impella RP的患者。在RV MCS之前，所有患者都需要静脉滴注肌力，7例(39%)需要吸入一氧化氮，7例(39%)需要主动脉内球囊反搏，2例(11%)经历过心脏骤停。心脏指数(植入前2.1+/-0.1升/分/米(2)比植入后2.6+/-0.2升/分/米(2)，p=0.04)和中心静脉压降低(22+/-5比15+/-4毫米汞柱，p<；0.01)。14例(78%)患者在支持7d(范围2-19d)后恢复了足够的RV功能以便于装置的解释，4例(22%)患者在支持后6d(范围1-11d)死亡。30天存活率为72%，1年存活率为50%。随访1年时，纽约心脏协会平均功能分级为1.3+/-0.5，超声心动图显示仅1例患者存在严重的右室功能障碍。结论：大多数ARVF患者迅速恢复了足够的RV功能，便于装置移植，这突显了微创临时RV辅助装置在治疗可恢复性ARVF中的作用。(C)2014年国际心肺移植学会。版权所有。
BACKGROUND: Acute right ventricular failure (ARVF) refractory to optimal medical management may require rescue therapy with mechanical circulatory support (MCS). The RV exhibits a greater capacity for rapid recovery than the left ventricle, making devices designed specifically for temporary RV MCS attractive. We report our experience with the Impella Right Direct (RD) and Right Peripheral (RP) temporary ventricular assist devices (Abiomed, Danvers, MA) in patients with ARVF.METHODS: We conducted a retrospective cohort study examining the clinical outcomes of consecutive patients supported with the Impella RD or RP at 2 institutions during a 6-year period.RESULTS: During the study period, 18 patients (67% men; mean age 57 +/- 10 years) received MCS, 15 with the Impella RD and 3 with the Impella RP. Before RV MCS, all patients required intravenous inotropes, 7 (39%) required inhaled nitric oxide, 7 (39%) required intra-aortic balloon counterpulsation, and 2(11%) had experienced a cardiac arrest. Device implantation resulted in an improvement in cardiac index (2.1 +/- 0.1 liters/min/m(2) pre-implant vs 2.6 +/- 0.2 liters/min/m(2) post-implant, p = 0.04) and reduced central venous pressure (22 +/- 5 vs 15 +/- 4 mm Hg, p < 0.01). Fourteen (78%) patients recovered sufficient RV function to facilitate device explanation after 7 days (range, 2-19 days) of support, and 4 (22%) patients died on support after 6 days (range 1-11 days). Survival to 30 days was 72% and to 1 year was 50%. At 1-year follow-up, the mean New York Heart Association functional classification was 1.3 +/- 0.5, and only 1 patient demonstrated severe RV dysfunction on echocardiography.CONCLUSIONS: Most patients with ARVF rapidly recover sufficient RV function to facilitate device explantation, highlighting an expanding role for minimally invasive temporary RV assist devices optimized for the treatment of recoverable ARVF. (C) 2014 International Society for Heart and Lung Transplantation. All rights reserved.