De Novo Aortic Insufficiency During Long-Term Support on a Left Ventricular Assist Device: A Systematic Review and Meta-Analysis
De Novo Aortic Insufficiency During Long-Term Support on a Left Ventricular Assist Device: A Systematic Review and Meta-Analysis
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DOI：
10.1097/mat.0000000000000042
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发表时间：
2014-03-01
期刊：
影响因子：
4.2
通讯作者：
Park, Soon J.
中科院分区：
文献类型：
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作者：
Deo, Salil V.;Sharma, Vikas;Park, Soon J.
在左心室辅助装置(LVAD)支持下，可能会发生主动脉瓣关闭不全(AI)。我们进行了一项系统的回顾，以确定在LVAD支持期间AI的发生率、预测因素和后果。在Medline上搜索原始研究，提供关于在LVAD植入过程中发生人工智能的患者的临床数据。选择了7项观察性研究(657名患者)进行回顾；65%的患者接受了连续流动装置(CF-LVAD)的植入。AI发生率为25%(11-42%)(支持期：412+/-281天)。AI每月增加4%(1-6%)(p<；0.01)。AI阳性患者在植入时年龄较大(加权平均差，7.7[4.3；11.1]；p<；0.01)。女性(0.002+/-0.001)和较小的体表面积(-0.003+/-0.001/m(2)；p<；0.01)与进展性AI相关。目的地治疗患者(优势比[OR]，5.3[1.2，24]；P=0.02)和使用CF-LVAD泵的患者可能发生AI(风险比[HR]，2.2[1.2，3.8]；P<；0.01)。主动脉瓣关闭与AI相关(OR，4.7[1.9，11.8]；p<；0.01)。两组患者的生存率具有可比性(HR，1.5[0.81，2.8]；p=0.2)。在LVAD支持期间，有相当数量的患者发展为新生AI。高龄、较长的支持时间、持续泵和关闭的主动脉瓣与AI相关。大量的队列研究将提高我们对这种情况的理解。
Aortic insufficiency (AI) may occur while supported on a left ventricular assist device (LVAD). We conducted a systematic review to determine the incidence, predictors, and consequences of AI during LVAD support. MEDLINE was searched for original studies presenting clinical data regarding patients who developed AI during LVAD implant. Seven observational studies (657 patients) were selected for review; 65% of patients underwent implantation with a continuous-flow device (Cf-LVAD). The incidence of AI was 25% (11-42%) (Support period: 412 +/- 281 days). AI increased by 4% (1-6%) per month of support (p < 0.01). AI-positive patients were older at implant (weighted mean difference, 7.7 [4.3; 11.1]; p < 0.01). Female sex (0.002 +/- 0.001; p = 0.01) and smaller body surface area (-0.003 +/- 0.001 per m(2); p < 0.01) correlated with progressive AI. Destination therapy patients (odds ratio [OR], 5.3 [1.2, 24]; p = 0.02) and those with Cf-LVAD pumps were likely to develop AI (hazard ratio [HR], 2.2 [1.2, 3.8]; p < 0.01). A closed aortic valve was associated with AI (OR, 4.7 [1.9, 11.8]; p < 0.01). Survival was comparable in both cohorts (HR, 1.5 [0.81, 2.8]; p = 0.2). A significant number of patients develop de novo AI during LVAD support. Advanced age, longer support duration, continuous-flow pumps, and a closed aortic valve are associated with AI. Large cohort studies would improve our understanding of this condition.