Is Bridge to Recovery More Likely With Pulsatile Left Ventricular Assist Devices Than With Nonpulsatile-Flow Systems?
Is Bridge to Recovery More Likely With Pulsatile Left Ventricular Assist Devices Than With Nonpulsatile-Flow Systems?
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DOI：
10.1016/j.athoracsur.2011.01.027
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发表时间：
2011-05-01
影响因子：
4.6
通讯作者：
Hetzer, Roland
中科院分区：
文献类型：
--
作者：
Krabatsch, Thomas;Schweiger, Martin;Hetzer, Roland
背景。特发性扩张型心肌病患者心肌恢复后脱离左心室辅助装置（LVAD）是一种临床选择。随着连续流泵的广泛应用，我们观察到由于这些特定患者的心肌恢复，可能的 LVAD 移植数量有所减少。我们调查了这种现象及其原因。方法。 1992年7月至2009年12月期间，387例特发性扩张型心肌病患者（年龄0.1至82岁）在我院接受了LVAD植入术。根据患者是否脱离 LVAD（A 组）或未脱离 LVAD（B 组），将患者分为两组。对 24 个可能影响心肌恢复的不同因素进行了单变量和多变量分析。结果。 34例因心肌恢复而切除LVAD，心功能长期稳定（撤机率8.8%）。使用脉动流 LVAD 的患者心肌恢复的机会几乎是接受连续流装置的患者的三倍（比值比，2.719；95% 置信区间，1.182 至 6.254）。年轻患者的康复率明显高于老年患者（比值比，1.036；95% 置信区间，1.016 至 1.057）。结论。在我们的分析中，脉动流 LVAD 和年轻年龄是特发性扩张型心肌病患者心肌恢复的重要因素。进一步的研究应该调查搏动本身或两类系统不同程度的左心室卸载是否在心肌恢复中发挥作用。
Background. Weaning from left ventricular assist devices (LVADs) after myocardial recovery in patients with idiopathic dilated cardiomyopathy is a clinical option. With the broad application of continuous-flow pumps, we observed a decrease in the numbers of possible LVAD explantations due to myocardial recovery in these particular patients. We investigated this phenomenon and its causes.Methods. Between July 1992 and December 2009, 387 patients (age, 0.1 to 82 years) with idiopathic dilated cardiomyopathy underwent LVAD implantation at our institution. Patients were divided into two groups depending on whether they were weaned from the LVAD (group A) or not (group B). Univariate and multivariate analyses were performed on 24 different factors with a possible influence on myocardial recovery.Results. In 34 patients, LVAD removal due to myocardial recovery was performed with long-term stable cardiac function (weaning rate, 8.8%). Patients with a pulsatile-flow LVAD had an almost threefold chance for myocardial recovery (odds ratio, 2.719; 95% confidence interval, 1.182 to 6.254) than patients who received continuous-flow devices. Younger patients had significantly higher recovery rates than older patients (odds ratio, 1.036; 95% confidence interval, 1.016 to 1.057).Conclusions. Pulsatile-flow LVADs and young age were important factors for myocardial recovery in idiopathic dilated cardiomyopathy patients in our analysis. Further studies should investigate whether pulsatility in itself or the different degrees of left ventricular unloading by the two types of systems play a role in myocardial recovery.