The Development of Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device-Supported Patients
The Development of Aortic Insufficiency in Continuous-Flow Left Ventricular Assist Device-Supported Patients
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DOI：
10.1016/j.athoracsur.2012.09.020
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发表时间：
2013-02-01
影响因子：
4.6
通讯作者：
Bhat, Geetha
中科院分区：
文献类型：
--
作者：
Aggarwal, Ashim;Raghuvir, Rashmi;Bhat, Geetha
背景左心室辅助装置（LVAD）置入后严重的主动脉瓣关闭不全（AI）会影响装置性能和终末器官灌注。本研究探讨了连续流LVAD植入后AI的发展和进展。检查了79例接受Heart Mate II（Thoratec Corp，普莱森顿，CA）LVAD植入术用于主要目的治疗的患者（n = 69 [87%]）。在0至3个月、3至6个月、6至12个月、12至18个月和18至24个月的时间间隔对所有患者的术前和术后超声心动图进行了审查。AI按0，无; 0.5，轻微; 1，轻度; 1.5，轻度至中度; 2，中度; 2.5，中度至重度; 3，重度的区间量表分级。分析了AI的发展和进展。显著AI（轻度或更高）的发生率为52%（n = 41）。AI发展的中位时间为187天。VAD支持的中位持续时间为761天。41例患者（52%）发生轻度AI。未发生严重AI。在考克斯回归模型（风险比[95%置信区间]）中，主动脉瓣关闭（2.51 [1.06 - 5.89]; p = 0.03）和年龄（1.04 [1.008 - 1.08]; p = 0.01）是AI发展的独立预测因素。两组的死亡率无差异（对数秩检验p = 0.40）。混合模型线性回归分析显示AI随时间的显著总体进展（β +/-标准误，0.06 +/- 0.02; p = 0.006）。随着时间的推移，AI在大量Heart Mate II LVAD患者中发展。AI在主动脉瓣关闭的患者和老年组中更常见。随着越来越多的患者需要长期的VAD支持，AI的发展将需要密切关注和监测。(Ann Thorac Surg 2013;95：493-9）（c）2013年，胸外科医师协会
Background. Significant aortic insufficiency (AI) after left ventricular assist device (LVAD) placement affects device performance and end-organ perfusion. This study examined the development and progression of AI after implantation of continuous-flow LVAD.Methods. Seventy-nine patients undergoing Heart Mate II (Thoratec Corp, Pleasanton, CA) LVAD implantation for predominantly destination therapy (n = 69 [87%]) were examined. Preoperative and postoperative echocardiograms for all patients were reviewed at the intervals of 0 to 3, 3 to 6, 6 to 12, 12 to 18, and 18 to 24 months. AI was graded on an interval scale of 0, none; 0.5, trivial; 1, mild; 1.5, mild to moderate; 2, moderate; 2.5, moderate to severe; and 3, severe. Development and progression of AI were analyzed.Results. The incidence of significant AI (mild or greater) was 52% (n = 41). Median time to AI development was 187 days. The median duration of VAD support was 761 days. Mild AI developed in 41 patients (52%). No severe AI developed. In the Cox regression model (hazard ratio [95% confidence interval]), aortic valve closure (2.51 [1.06 to 5.89]; p = 0.03), and age (1.04 [1.008 to 1.08]; p = 0.01) were independent predictors of AI development. There was no difference in mortality rates in the two groups (p = 0.40 by log-rank test). A mixed-model linear regression analysis showed a significant overall progression of AI over time (beta +/- standard error, 0.06 +/- 0.02; p = 0.006).Conclusions. AI develops over time in a significant number of Heart Mate II LVAD patients. AI is more common in patients with closed aortic valves and in the older age group. As more patients require long-term VAD support, the development of AI will need careful attention and monitoring. (Ann Thorac Surg 2013;95:493-9) (c) 2013 by The Society of Thoracic Surgeons