Management of aortic insufficiency in the continuous flow left ventricular assist device population.
Management of aortic insufficiency in the continuous flow left ventricular assist device population.
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DOI：
10.1007/s11897-013-0172-6
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发表时间：
2014-03-01
影响因子：
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通讯作者：
Teuteberg, Jeffrey
中科院分区：
文献类型：
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作者：
Holtz, Jonathan;Teuteberg, Jeffrey
借助最新一代的连续流 (CF) 左心室辅助装置 (LVAD)，患者能够获得更长时间的支持。因此，人们越来越关注长期机械循环支持引起的长期并发症，例如获得性主动脉瓣关闭不全（AI）。在存在 LVAD 的情况下，AI 会导致盲循环，一部分 LVAD 输出通过主动脉瓣 (AV) 回流到左心室，然后再通过该装置返回，限制有效的前向血流，最终导致器官灌注不良和左心室舒张压升高。由于 CF LVAD 存在时瓣膜打开受限，AV 也会出现异常的生物力学。剪切应力的增加、跨瓣压力梯度的升高和瓣膜打开时间的减少都有助于获得 AI。 LVAD 患者中度至重度 AI 的预后通常较差，导致 AV 更换率较高，并可能降低生存率。然而，没有基于证据的指南来管理这一具有挑战性的人群。对于严重的人工智能，专家通常主张更换或修复自动驾驶，而较小程度的人工智能可以通过医疗和/或调整泵参数进行管理。
With the current generation of continuous-flow (CF) left ventricular assist devices (LVADs), patients are able to be supported for longer periods of time. As a result, there has been increasing focus on long-term complications from prolonged mechanical circulatory support, such as acquired aortic insufficiency (AI). In the presence of an LVAD, AI leads to a blind circulatory loop, with a portion of LVAD output regurgitating through the aortic valve (AV) into the left ventricle and back again through the device, limiting effective forward flow and ultimately leading to organ malperfusion and increased left ventricular diastolic pressures. The AV also experiences abnormal biomechanics as a result of limited valve opening in the presence of a CF LVAD. Increased shear stress, elevated transvalvular pressure gradients, and decreased valve open time all contribute to acquired AI. The prognosis of moderate to severe AI in LVAD patients is generally poor and leads to a higher rate of AV replacement and potentially reduced survival. However, there are no evidence-based guidelines for management of this challenging population. In severe AI, experts generally advocate AV replacement or repair, while lesser degrees of AI can be managed medically and/or with adjustments in pump parameters.