The influence of pump rotation speed on hemodynamics and myocardial oxygen metabolism in left ventricular assist device support with aortic valve regurgitation
The influence of pump rotation speed on hemodynamics and myocardial oxygen metabolism in left ventricular assist device support with aortic valve regurgitation
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泵转速对主动脉瓣关闭不全左心辅助装置支持血流动力学及心肌氧代谢的影响
DOI：
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发表时间：
2017
影响因子：
1.3
通讯作者：
E. Tatsumi
中科院分区：
文献类型：
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作者：
Kei Iizuka;T. Nishinaka;Y. Takewa;K. Yamazaki;E. Tatsumi
主动脉瓣反流（AR）是左心室辅助装置（LVAD）支持下的严重并发症。AR导致LVAD-左心室（LV）再循环，这使得难以继续LVAD支持。然而，左心室辅助装置（LVAD）与AR的血流动力学和心肌氧代谢尚不清楚，特别是泵转速如何影响它们。建立了左心室辅助装置（LVAD）伴主动脉瓣反流（AR）动物模型，并在急性动物实验中观察了泵转速对血流动力学和心肌氧代谢的影响。5只山羊（55 ± 9.3kg）行离心式LVAD、EVAHEART植入术。通过在主动脉瓣内放置腔静脉滤器建立AR模型。通过改变泵转速（有或无AR（AR+，AR-））评价血流动力学值和心肌耗氧量、输送量和氧摄取率（O2 ER）。AR+被定义为卖方分类3或更高。在5只山羊中成功地诱导了AR。AR+组的主动脉舒张压显著低于AR-组（p = 0.026）。AR+组的中心静脉压、平均左心房压和左心室舒张压显著高于AR-组（分别为p = 0.010、0.047和0.0083）。尽管体循环流量并未随着泵转速的增加而改善，但在AR+中LVAD泵流量的增加超过了体循环流量，这意味着泵转速的增加了LVAD-LV再循环，并且无助于有效的体循环。AR-中的O2 ER随泵转速的增加而降低，但AR+中的O2 ER很难降低。AR+中的O2 ER与LVAD-LV再循环的流速呈正相关（p = 0.012）。AR引起LVAD-LV再循环，干扰LVAD支持的心脏辅助，并使其在高泵转速下无效。
Aortic valve regurgitation (AR) is a serious complication under left ventricular assist device (LVAD) support. AR causes LVAD-left ventricular (LV) recirculation, which makes it difficult to continue LVAD support. However, the hemodynamics and myocardial oxygen metabolism of LVAD support with AR have not been clarified, especially, how pump rotation speed influences them. An animal model of LVAD with AR was newly developed, and how pump rotation speed influences hemodynamics and myocardial oxygen metabolism was examined in acute animal experiments. Five goats (55 ± 9.3 kg) underwent centrifugal type LVAD, EVAHEART implantation. The AR model was established by placing a vena cava filter in the aortic valve. Hemodynamic values and the myocardial oxygen consumption, delivery, and oxygen extraction ratio (O2ER) were evaluated with changing pump rotation speeds with or without AR (AR+, AR−). AR+ was defined as Sellers classification 3 or greater. AR was successfully induced in five goats. Diastolic aortic pressure was significantly lower in AR+ than AR− (p = 0.026). Central venous pressure, mean left atrial pressure, and diastolic left ventricular pressure were significantly higher in AR+ than AR− (p = 0.010, 0.047, and 0.0083, respectively). Although systemic flow did not improve with increasing pump rotation speed, LVAD pump flow increased over systemic flow in AR+, which meant increasing pump rotation speed increased LVAD-LV recirculation and did not contribute to effective systemic circulation. O2ER in AR− decreased with increasing pump rotation speed, but O2ER in AR+ was hard to decrease. The O2ER in AR+ correlated positively with the flow rate of LVAD-LV recirculation (p = 0.012). AR caused LVAD-LV recirculation that interfered with the cardiac assistance of LVAD support and made it ineffective to manage with high pump rotation speed.