Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure.
Left Ventricular Assist Device as a Bridge to Recovery for Patients With Advanced Heart Failure.
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DOI：
10.1016/j.jacc.2017.02.018
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发表时间：
2017-04-18
影响因子：
24
通讯作者：
Tan LB
中科院分区：
文献类型：
--
作者：
Jakovljevic DG;Yacoub MH;Schueler S;MacGowan GA;Velicki L;Seferovic PM;Hothi S;Tzeng BH;Brodie DA;Birks E;Tan LB
左心室辅助装置（LVAD）已被用作晚期心力衰竭患者的有效治疗选择，无论是作为移植的桥梁，还是作为目的地治疗，或者在某些患者中，作为恢复的桥梁。本研究评估了接受LVAD桥接至恢复方案的患者是否可以达到与健康对照组相当的心脏和身体功能能力。58名男性患者（18名植入连续流LVAD，16名LVAD患者（恢复患者）和24名心脏移植候选人（HTx））和97名健康对照者进行了最大分级心肺运动试验，连续测量呼吸气体交换和无创（再呼吸）血流动力学数据。心功能用运动峰值心输出量（平均动脉压×心输出量）表示，功能容量用运动峰值耗氧量表示。所有患者均表现出显著的劳力性努力，如平均峰值运动呼吸交换率>1.10所示。与其他患者相比，健康对照组和LVAD患者的峰值运动心功率输出量显著较高（健康5.35 ± 0.95 W;起搏3.45 ± 0.72 W; LVAD植入2.37 ± 0.68 W; HTx 1.31 ± 0.31 W; p < 0.05），峰值O2消耗量也是如此（健康36.4 ± 10.3 ml/kg/min;植入29.8 ± 5.9 ml/kg/min;植入20.5 ± 4.3 ml/kg/min; HTx 12.0 ± 2.2 ml/kg/min; p < 0.05）。在LVAD治疗组中，38%的患者达到峰值心输出量，69%的患者达到峰值O2消耗量，均在健康对照组范围内。作者已经表明，相当数量的患者恢复到足以允许他们的LVAD恢复，甚至可以实现心脏和身体功能的能力几乎等同于健康对照。
Left ventricular assist devices (LVADs) have been used as an effective therapeutic option in patients with advanced heart failure, either as a bridge to transplantation, as destination therapy, or in some patients, as a bridge to recovery. This study evaluated whether patients undergoing an LVAD bridge-to-recovery protocol can achieve cardiac and physical functional capacities equivalent to those of healthy controls. Fifty-eight male patients—18 implanted with a continuous-flow LVAD, 16 patients with LVAD explanted (recovered patients), and 24 heart transplant candidates (HTx)—and 97 healthy controls performed a maximal graded cardiopulmonary exercise test with continuous measurements of respiratory gas exchange and noninvasive (rebreathing) hemodynamic data. Cardiac function was represented by peak exercise cardiac power output (mean arterial blood pressure × cardiac output) and functional capacity by peak exercise O2 consumption. All patients demonstrated a significant exertional effort as demonstrated with the mean peak exercise respiratory exchange ratio >1.10. Peak exercise cardiac power output was significantly higher in healthy controls and explanted LVAD patients compared with other patients (healthy 5.35 ± 0.95 W; explanted 3.45 ± 0.72 W; LVAD implanted 2.37 ± 0.68 W; and HTx 1.31 ± 0.31 W; p < 0.05), as was peak O2 consumption (healthy 36.4 ± 10.3 ml/kg/min; explanted 29.8 ± 5.9 ml/kg/min; implanted 20.5 ± 4.3 ml/kg/min; and HTx 12.0 ± 2.2 ml/kg/min; p < 0.05). In the LVAD explanted group, 38% of the patients achieved peak cardiac power output and 69% achieved peak O2 consumption within the ranges of healthy controls. The authors have shown that a substantial number of patients who recovered sufficiently to allow explantation of their LVAD can even achieve cardiac and physical functional capacities nearly equivalent to those of healthy controls.