Aortic root thrombosis in patients supported with continuous-flow left ventricular assist devices
Aortic root thrombosis in patients supported with continuous-flow left ventricular assist devices
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DOI：
10.1016/j.healun.2018.07.012
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发表时间：
2018-12-01
影响因子：
8.9
通讯作者：
Topkara, Veli K.
中科院分区：
文献类型：
--
作者：
Fried, Justin;Garan, Arthur R.;Topkara, Veli K.
背景：主动脉根部血栓形成(ART)是近年来公认的持续性左心室辅助装置(CF-LVAD)治疗的并发症。然而，对这种并发症的发生率或临床意义知之甚少。我们研究的目的是系统地评估ART在CF-LVAD支持中的发生率和意义。方法：我们回顾了2004年4月至2016年6月在哥伦比亚大学医学中心接受HeartMate II或HeartWare HVAD-LVAD植入的所有患者。系统回顾超声心动图研究以确定发生ART的患者。结果：436例CF-LVAD患者中有21例(4.8%)在植入CF-LVAD后中位时间为22天(四分位数范围为3~56天)确诊为ART。ART最常见的部位为非冠状静脉尖部受累(n=15，71.4%)，合并右室衰竭14例(66.7%)。ART诊断后1年和2年的精算生存率分别为73.8%和44.3%。ART与较高的并发症发生率相关，包括卒中(28.6%，0.337例/患者年)和临床意义上的MI(28.6%，0.337例/年)。结论：在CF-LVAD患者中，ART并不少见，并且与显著的发病率和死亡率有关。鉴于ART患者卒中和心肌梗死的早期发生和高发生率，应该实施监测和治疗策略来解决这一潜在的破坏性并发症。(C)2018国际心肺移植学会。版权所有。
BACKGROUND: Aortic root thrombosis (ART) is a recently recognized complication of continuous-flow left ventricular assist device (CF-LVAD) therapy. However, little is known about the prevalence or clinical significance of this complication. The aim of our study was to systematically evaluate the incidence and significance of ART on CF-LVAD support.METHODS: We retrospectively reviewed all patients who underwent HeartMate II or HeartWare HVAD CF-LVAD implantation from April 2004 through June 2016 at the Columbia University Medical Center. Echocardiography studies were systematically reviewed to identify patients who developed ART. Study outcomes included post-ART survival on CF-LVAD support, stroke, pump thrombosis, and clinically significant myocardial infarction (MI).RESULTS: The study cohort consisted of 436 CF-LVAD patients with 21 patients (4.8%) diagnosed with confirmed ART at a median time of 22 days (interquartile range [IQR] 3 to 56 days) after CF-LVAD implantation. Involvement of the non-coronary cusp was the most common location of the ART (n=15, 71.4%) and concomitant RV failure occurred in 14 patients (66.7%). Actuarial survival at 1 and 2 years after diagnosis of ART was 73.8% and 44.3%, respectively. ART was associated with a high rate of complications, including stroke (28.6%, 0.337 episode per patient-year [EPPY]) and clinically significant MI (28.6%, 0.337 EPPY).CONCLUSIONS: ART is not uncommon after CF-LVAD implantation and is associated with significant morbidity and mortality in CF-LVAD patients. Given the early occurrence and high incidence of stroke and MI in patients who develop ART, surveillance and treatment strategies should be implemented to address this potentially devastating complication. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.