Acute impact of left ventricular unloading by left ventricular assist device on the right ventricle geometry and function: Effect of nitric oxide inhalation
Acute impact of left ventricular unloading by left ventricular assist device on the right ventricle geometry and function: Effect of nitric oxide inhalation
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DOI：
10.1016/j.jtcvs.2010.08.010
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发表时间：
2011-04-01
影响因子：
6
通讯作者：
Habazettl, Helmut
中科院分区：
文献类型：
--
作者：
Kukucka, Marian;Potapov, Evgenij;Habazettl, Helmut
目的：左心室辅助装置（LVAD）植入术是治疗终末期心力衰竭患者的一种既定选择，但右心室衰竭可能会使预后恶化。本研究的目的是评估左心室辅助功能对右心室几何形状和功能以及肺循环的急性影响。评估吸入一氧化氮（iNO）的效果。方法：我们评估了参加一项随机试验的患者在LVAD植入期间吸入一氧化氮的影响的术前和术后获得的经食管超声心动图图像和血流动力学。24名患者随机分为iNO组，23名患者分为安慰剂组。结果：两组患者在LVAD植入后肺毛细血管楔压（P < 0.01）和平均肺动脉压（P < 0.01）均明显降低。肺血管阻力仅在iNO组降低（311 +/- 35 ~ 225 +/- 17,P < 0.01）。多角度测量显示显著改善右心室几何(右心室舒张末期直径:50 + / - 2 45 + / - 2,P < . 01和48 + / - 2 44 + / - 2毫米,在伊诺和安慰剂组P < . 05)和功能(右心室部分区域变化:24% + / - 2%至31% + / - 2%,P < . 05和23% + / - 2%到29% + / - 2%,P < . 05伊诺和安慰剂组)伊诺和安慰剂组没有任何区别。术后右心衰的总发生率为4 / 47（8.5%）。结论：LVAD植入明显改善了大多数患者的右心室形状和功能，可能是通过解决左心室充血从而减少右心室后负荷。iNO的有益作用可能被左心室卸荷对右心室功能更明显的影响所掩盖。[J] .中华胸心外科杂志；2011;41(1):391 - 391。
Objective: Left ventricular assist device (LVAD) implantation is an established option for treatment of patients with end-stage heart failure, but outcome may be worsened by right ventricular failure. The aim of this study was to evaluate the acute effect of LVAD on right ventricular geometry and function and the pulmonary circulation. The effect of inhaled nitric oxide (iNO) was assessed.Methods: We evaluated pre- and postoperatively obtained transesophageal echocardiography images and hemodynamics of patients participating in a randomized trial on the effect of inhaled nitric oxide during LVAD implantation. Twenty-four patients were randomized to the iNO group and 23 to the placebo group.Results: After LVAD implantation marked decreases in pulmonary capillary wedge pressure (P < .01) and mean pulmonary artery pressure (P < .01) were observed in both groups. Pulmonary vascular resistance decreased only in the iNO group (311 +/- 35 to 225 +/- 17, P < .01). Transesophageal echocardiography measurements show significant improvement of right ventricular geometry (right ventricular end-diastolic diameter: 50 +/- 2 to 45 +/- 2, P < .01 and 48 +/- 2 to 44 +/- 2 mm, P < .05 in iNO and placebo groups) and function (right ventricular fractional area change: 24% +/- 2% to 31% +/- 2%, P < .05 and 23% +/- 2% to 29% +/- 2%, P < .05 in iNO and placebo groups) without any difference between the iNO and placebo groups. The overall incidence of postoperative right ventricular failure was 4 of 47 (8.5%).Conclusions: LVAD implantation markedly improved right ventricular geometry and function in most of the patients, probably by resolving left ventricular congestion and thus reducing right ventricular afterload. Beneficial effects of iNO may have been masked by more pronounced consequences of left ventricular unloading on right ventricular function. (J Thorac Cardiovasc Surg 2011;141:1009-14)