Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes
Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: Incidence, risk factors, and effect on outcomes
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DOI：
10.1016/j.jtcvs.2009.11.020
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发表时间：
2010-05-01
影响因子：
6
通讯作者：
Farrar, David J.
中科院分区：
文献类型：
--
作者：
Kormos, Robert L.;Teuteberg, Jeffrey J.;Farrar, David J.
目的：本研究的目的是评估的发病率，风险因素，并在一个大的人口植入连续流左心室辅助devices.Methods的患者（n = 484）的结果右心室衰竭的发生率进行了检查，在HeartMate II左心室辅助设备（Thoratec，普莱森顿，加利福尼亚州）桥移植的临床试验。右心室衰竭定义为需要右心室辅助装置，植入后14天或以上的正性肌力支持，和/或植入后14天以上开始的正性肌力支持。人口统计学，沿着与临床，实验室和血流动力学数据，比较患者和无右心室衰竭，和危险因素identified.Results：总体而言，30（6%）患者接受左心室辅助装置需要右心室辅助装置，35（7%）需要延长的正性肌力药，和33（7%）需要晚期正性肌力药。与右心室衰竭患者相比，无右心室衰竭患者在180天时存活至移植、恢复或持续器械支持的百分比显著更高（89% vs 71%，P <0.001）。多变量分析显示，中心静脉压/肺毛细血管楔压比值大于0.63（比值比，2.3; 95%置信区间，1.2-4.3; P = 0.009），需要术前呼吸机支持（比值比，5.5; 95%置信区间，2.3-13.2; P < .001），血尿素氮水平大于39 mg/dL（比值比，2.1; 95%可信区间，1.1-4.1; P = 0.02）是左心室辅助装置植入后右心室衰竭的独立预测因素。使用HeartMate II心室辅助装置的患者的右心室衰竭发生率与使用搏动性心脏起搏器的患者相当或更低，流动装置其发生与无右心室衰竭患者的结局更差相关。有右心室衰竭风险的患者可能受益于术前右心功能优化或计划的双心室支持。（《胸血管外科杂志》2010; 139：1316-24）
Objective: The aim of this study was to evaluate the incidence, risk factors, and effect on outcomes of right ventricular failure in a large population of patients implanted with continuous-flow left ventricular assist devices.Methods: Patients (n = 484) enrolled in the HeartMate II left ventricular assist device (Thoratec, Pleasanton, Calif) bridge-to-transplantation clinical trial were examined for the occurrence of right ventricular failure. Right ventricular failure was defined as requiring a right ventricular assist device, 14 or more days of inotropic support after implantation, and/or inotropic support starting more than 14 days after implantation. Demographics, along with clinical, laboratory, and hemodynamic data, were compared between patients with and without right ventricular failure, and risk factors were identified.Results: Overall, 30 (6%) patients receiving left ventricular assist devices required a right ventricular assist device, 35 (7%) required extended inotropes, and 33 (7%) required late inotropes. A significantly greater percentage of patients without right ventricular failure survived to transplantation, recovery, or ongoing device support at 180 days compared with patients with right ventricular failure (89% vs 71%, P < .001). Multivariate analysis revealed that a central venous pressure/pulmonary capillary wedge pressure ratio of greater than 0.63 (odds ratio, 2.3; 95% confidence interval, 1.2-4.3; P = .009), need for preoperative ventilator support (odds ratio, 5.5; 95% confidence interval, 2.3-13.2; P < .001), and blood urea nitrogen level of greater than 39 mg/dL (odds ratio, 2.1; 95% confidence interval, 1.1-4.1; P = .02) were independent predictors of right ventricular failure after left ventricular assist device implantation.Conclusions: The incidence of right ventricular failure in patients with a HeartMate II ventricular assist device is comparable or less than that of patients with pulsatile-flow devices. Its occurrence is associated with worse outcomes than seen in patients without right ventricular failure. Patients at risk for right ventricular failure might benefit from preoperative optimization of right heart function or planned biventricular support. (J Thorac Cardiovasc Surg 2010; 139: 1316-24)