Improved left ventricular function after chronic left ventricular unloading
Improved left ventricular function after chronic left ventricular unloading
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DOI：
10.1016/s0003-4975(96)00437-7
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发表时间：
1996-09-01
影响因子：
4.6
通讯作者：
Buja, LM
中科院分区：
文献类型：
--
作者：
Frazier, OH;Benedict, CR;Buja, LM
背景本研究评估了延长左心室负荷对自体心室功能的影响。我们回顾了31例患者（30例男性，1例女性）使用HeartMate左心室辅助系统支持超过30天（平均137天;范围31至505天）的数据。患者的平均年龄为46岁（范围，22至64岁）; 17例患有特发性心肌病，14例患有缺血性心肌病。在HeartMate植入时、器械临时支持期间和器械取出时收集数据（解剖学、生理学、血流动力学、组织学和生化）。常规胸部X线片显示心胸比率改善（0.62 +/- 0.04至0.55 +/- 0.03; p < 0.0001）。在泵关闭的情况下进行的超声心动图显示左心室舒张末期尺寸显著降低（6.81 +/- 0.87 cm至5.39 +/- 1.08 cm; p < 0.0005），射血分数显著改善（0.11 +/- 0.05至0.22 +/- 0.17; p < 0.02）。心脏指数增加（1.96 +/- 0.52 L。min（-1）。m（-2）至2.93 +/- 0.73 L。min（-1）m（-2）; p < 0.0001），平均主动脉压升高（71.40 +/- 10.63 mm Hg至76.33 +/- 16.84 mm Hg; p = 0.48），肺毛细血管楔压降低（24.18 +/- 6.27 mm Hg至14.48 +/- 3.01 mm Hg; p < 0.0001），肺血管阻力降低（3.34 +/- 2.00 Wood单位至2.51 +/- 0.88 Wood单位; p < 0.05）。植入时和移植时采集的组织样本的比较显示肌细胞溶解显著减少。研究患者的钙摄取、钙结合率和脂质水平正常化。血浆去甲肾上腺素水平下降至接近正常水平。现在有前瞻性研究表明，在选定的患者中，器械取出而不进行移植是否有益。
Background. This study assessed the effect of prolonged left ventricular unloading on native ventricular function.Methods. We reviewed data from 31 patients (30 men, 1 woman) supported more than 30 days (mean, 137 days; range, 31 to 505 days) with the HeartMate left ventricular assist system. The patients' mean age was 46 years (range, 22 to 64 years); 17 had idiopathic and 14 had ischemic cardiomyopathy. Data (anatomic, physiologic, hemodynamic, histologic, and biochemical) were collected at the time of HeartMate implantation, during support with the device temporarily oh, and at the time of device explantation.Results. Routine chest roentgenogram showed improvement in cardiothoracic ratio (0.62 +/- 0.04 to 0.55 +/- 0.03; p < 0.0001). Echocardiography performed with the pump off showed a significant decrease in left ventricular end-diastolic dimension (6.81 +/- 0.87 cm to 5.39 +/- 1.08 cm; p < 0.0005) and a significant improvement in ejection fraction (0.11 +/- 0.05 to 0.22 +/- 0.17; p < 0.02). Cardiac index increased (1.96 +/- 0.52 L . min(-1). m(-2) to 2.93 +/- 0.73 L . min(-1) m(-2); p < 0.0001), mean aortic pressure increased (71.40 +/- 10.63 mm Hg to 76.33 +/- 16.84 mm Hg; p = 0.48), pulmonary capillary wedge pressure decreased (24.18 +/- 6.27 mm Hg to 14.48 +/- 3.01 mm Hg; p < 0.0001), and pulmonary vascular resistance decreased (3.34 +/- 2.00 Wood units to 2.51 +/- 0.88 Wood units; p < 0.05). Comparisons of tissue samples taken at the time of implantation and at the time of transplantation showed a marked reduction in myocytolysis. Calcium uptake, calcium-binding rates, and lipid levels normalized in patients studied. Plasma norepinephrine levels decreased to near normal levels.Conclusion. Prospective studies are now indicated to determine whether device removal without transplantation may be beneficial in selected patients.