Surgical correction of aortic valve insufficiency after left ventricular assist device implantation
Surgical correction of aortic valve insufficiency after left ventricular assist device implantation
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DOI：
10.1016/j.jtcvs.2013.05.019
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发表时间：
2013-11-01
影响因子：
6
通讯作者：
Milano, Carmelo A.
中科院分区：
文献类型：
--
作者：
Atkins, B. Zane;Hashmi, Zubair A.;Milano, Carmelo A.
目的：新发主动脉瓣关闭不全（AI）可在建立机械循环支持后遇到，与脉动装置相比，连续流（CF）左心室辅助装置（LVAD）似乎更常见和严重。LVAD术后新发AI的治疗算法尚未明确定义。在本报告中，我们描述了6例接受主动脉瓣手术治疗LVAD术后新发AI的患者。方法：从2005年至2011年，271例患者接受LVAD植入术。在这些LVAD中，225件为CF器械（203件HeartMate II器械，Thoratec Corp，普莱森顿，加利福尼亚州; 22件HVAD器械，HeartWare Intl，Inc，马萨诸塞州弗莱森顿）。结果：随访期间，6例CF LVAD患者发生了新的严重AI，伴有心力衰竭。在药物治疗失败后，4例患者接受了再次胸骨切开术进行主动脉瓣手术（1例生物瓣膜置换术，1例涤纶补片闭合术和2例主动脉瓣修复术），2例患者接受了经导管主动脉瓣手术，其中1例需要通过开放手术进行主动脉瓣置换术翻修。6例患者中，5例患者的功能和症状明显改善。一名患者术后死亡继发于多器官功能衰竭和sepsis.Conclusions：手术治疗后LVAD AI与主动脉瓣缝合或瓣叶修复或生物主动脉瓣置换术是有效的CF LVAD患者发展症状，严重AI恢复功能的能力，可以安全地进行良好的效果。各种经导管的方法，这些困难的问题，也可提供微创替代传统手术。
Objectives: New-onset aortic insufficiency (AI) can be encountered after instituting mechanical circulatory support and seems more common and severe with continuous flow (CF) left ventricular assist devices (LVADs) compared with pulsatile devices. Treatment algorithms for de novo, post-LVAD AI have not been well defined. In the present report, we have described 6 patients who underwent aortic valve surgery for new-onset post-LVAD AI.Methods: From 2005 to 2011, 271 patients underwent LVAD implantation. Of these LVADs, 225 were CF devices (203 HeartMate II devices, Thoratec Corp, Pleasanton, Calif; and 22 HVAD devices, HeartWare Intl, Inc, Framingham, Mass). The patients were examined for new-onset severe AI requiring surgical intervention.Results: During follow-up, 6 CF LVAD patients developed new, severe AI that was accompanied by heart failure. After medical therapy had failed, 4 patients underwent redo sternotomy for aortic valve procedures (1 bioprosthetic valve replacement, 1 Dacron patch closure, and 2 aortic valve repairs), and 2 patients underwent transcatheter aortic valve procedure, with 1 requiring revision by open surgery for aortic valve replacement. Of the 6 patients, 5 experienced significant improvement in functional capacity and symptoms. One patient died postoperatively secondary to multiorgan failure and sepsis.Conclusions: Surgical treatment of post-LVAD AI with aortic valve oversewing or leaflet repair or by bioprosthetic aortic valve replacement is effective at restoring functional capacity for CF LVAD patients who develop symptomatic, severe AI and can be performed safely with good results. Various transcatheter approaches to these difficult problems are also available and offer less invasive alternatives to conventional surgery.