Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices
Prevalence of de novo aortic insufficiency during long-term support with left ventricular assist devices
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DOI：
10.1016/j.healun.2010.05.018
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发表时间：
2010-10-01
影响因子：
8.9
通讯作者：
Jorde, Ulrich P.
中科院分区：
文献类型：
--
作者：
Pak, Sang-Woo;Uriel, Nir;Jorde, Ulrich P.
背景：左心室辅助装置（LVAD）越来越多地用作终末期心力衰竭患者的长期治疗。我们比较了心脏伴侣II（HMII）与心脏伴侣XVE（HMI）支持后主动脉瓣关闭不全（AI）的患病率，并评估了主动脉根部直径和主动脉瓣开口在AI.METHOD发展中的作用：对2004年1月至2009年9月期间在我们中心接受植入物的93例HMI和73例HMII患者的术前和术后超声心动图进行了回顾性分析。在排除了既往或同期主动脉瓣手术操作、基线AI或无基线回声的患者后，研究了67例HMI和63例HM II患者。如果轻度至中度或更高，则认为AI显著。结果：67例HMI患者中4例（6.0%）发生AI，63例HMII患者中9例（14.3%）发生AI。HMI患者发生AI的中位时间为48天，HMII患者为90天。对于在6个月和12个月时仍接受器械支持的患者，HMI患者的无AI率分别为94.5%和88.9%，HMII患者为83.6%和75.2%（对数秩p = 0.194）。通过超声心动图确定的AI患者的主动脉根部直径在基线（3.43 +/- 0.43 vs 3.15 +/- 0.40; p = 0.067）和随访（3.58 +/- 0.54 vs 3.29 +/- 0.50; p = 0.130）时与未患AI的患者相比有更大的趋势。在接受移植的患者中，由病理学家直接评估主动脉根部周长，与未发生AI的患者相比，发生AI的HMII患者的主动脉根部周长显著更大（8.44 +/- 0.89 vs 7.36 +/- 1.02 cm; p = 0.034）。最后，AI在主动脉瓣热开放的患者中更常见（11/26 vs 1/14; p = 0.03）。结论：主动脉瓣关闭不全经常发生在接受连续流支持的患者中，并可能与主动脉根部直径扩大和主动脉瓣开放有关。这些发现需要更彻底的术前患者评估和额外的研究来调查可能与AI发展相关的因素。心肺移植2010;XX：xxx-xxx J Heart Lung Transplant 2010;29：1172-6（C）2010国际心肺移植学会。All rights reserved.
BACKGROUND: Left ventricular assist devices (LVADs) are increasingly used as long-term therapy for end-stage heart failure patients. We compared the prevalence of aortic insufficiency (AI) after Heart Mate II (HMII) vs Heart Mate XVE (HMI) support and assessed the role of aortic root diameter and aortic valve opening in the development of AI.METHOD: Pre-operative and post-operative echocardiograms of 93 HMI and 73 HMII patients who received implants at our center between January 2004 and September 2009 were retrospectively reviewed. After excluding patients with prior or concurrent surgical manipulation of the aortic valve, with baseline AI, or without baseline echoes, 67 HMI and 63 HMII patients were studied. AI was deemed significant if mild to moderate or greater. Pathology reports were reviewed for 77 patients who underwent heart transplant.RESULTS: AI developed in 4 of 67 HMI (6.0%) and in 9 of 63 HMII patients (14.3%). The median times to AI development were 48 days for HMI patients and 90 days for HMII patients. For patients who remained on device support at 6 and 12 months, freedom from AI was 94.5% and 88.9% in HMI patients and 83.6% and 75.2% in HMII patients (log rank p = 0.194). Aortic root diameters, as determined by echocardiography for the patients with AI, trended to be larger at baseline (3.43 +/- 0.43 vs 3.15 +/- 0.40; p = 0.067) and follow-up (3.58 +/- 0.54 vs 3.29 +/- 0.50; p = 0.130) compared with those who did not have AI. Aortic root circumferences were assessed directly by a pathologist in those patients who underwent transplant and were significantly larger in HMII patients who had developed AI compared with those patients who did not (8.44 +/- 0.89 vs 7.36 +/- 1.02 cm; p = 0.034). Lastly, AI was more common in patients whose aortic valve did hot open (11 of 26 vs 1 of 14; p = 0.03).CONCLUSION: Aortic insufficiency occurs frequently in patients who receive continuous-flow support with a HMII LVAD, and may be associated with aortic root diameter enlargement and aortic valve opening. These findings warrant a more thorough preoperative patient evaluation and additional studies to investigate the factors, that may be associated with AI development. Heart Lung Transplant 2010;XX:xxx-xxx J Heart Lung Transplant 2010;29:1172-6 (C) 2010 International Society for Heart and Lung Transplantation. All rights reserved.