Role of the mitral valve in left ventricular assist device pathophysiology.
Role of the mitral valve in left ventricular assist device pathophysiology.
复制标题
DOI：
10.3389/fcvm.2022.1018295
复制
发表时间：
2022
影响因子：
3.6
通讯作者：
中科院分区：
文献类型：
--
作者：
心力衰竭背景下的功能性二尖瓣返流（MR）由左心室（LV）和二尖瓣环的进行性扩张引起。这导致瓣叶栓系伴后移。与通常的假设相反，二尖瓣返流通常不能单独通过LVAD对LV进行减压来解决。在LVAD设置中，显著（中度-重度）二尖瓣返流的负面影响在其对右心功能、肺血管阻力和再入院的有害影响方面得到了更好的认识。然而，关于干预和管理的门槛仍然存在争议。目前，由于二尖瓣返流对临床结局的潜在不良影响的数据相互矛盾，因此在LVAD植入时修复严重二尖瓣返流尚无共识适应症。在这篇综述中，我们总结了目前对LVAD患者MR病理生理学的理解和未来潜在的管理策略。
Functional mitral regurgitation (MR) in the setting of heart failure results from progressive dilatation of the left ventricle (LV) and mitral annulus. This leads to leaflet tethering with posterior displacement. Contrary to common assumptions, MR often does not resolve with LVAD decompression of the LV alone. The negative impact of significant (moderate-severe) mitral regurgitation in the LVAD setting is becoming better recognized in terms of its harmful effect on right heart function, pulmonary vascular resistance and hospital readmissions. However, controversies remain regarding the threshold for intervention and management. At present, there are no consensus indications for the repair of significant mitral regurgitation at the time of LVAD implantation due to the conflicting data regarding potential adverse effects of MR on clinical outcomes. In this review, we summarize the current understanding of MR pathophysiology in patients supported with LVAD and potential future management strategies.