Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion
Preoperative risk factors for right ventricular failure after implantable left ventricular assist device insertion
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DOI：
10.1016/s0003-4975(99)00753-5
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发表时间：
1999-12-01
影响因子：
4.6
通讯作者：
Young, JB
中科院分区：
文献类型：
--
作者：
Fukamachi, K;McCarthy, PM;Young, JB
背景资料。植入性左心辅助装置(LVAD)置入后并发早期右室功能衰竭，预后不良，且一般不可预测。为了确定左心瓣膜置入术后发生右室衰竭的术前危险因素，对克利夫兰诊所100例心脏晚期左心功能衰竭患者的临床特征和术前血流动力学进行了分析。II组(RVAD组)需要RV辅助装置支持。在年轻患者、女性患者、较小患者和心肌炎患者中，RVAD的使用率显著较高。两组患者术前心脏指数、右室射血分数和右房压力均无显著差异。RVAD组术前平均肺动脉压(PAP)和右室每搏做功指数(RV SWI)显著低于对照组(P分别为0.015和0.011)。RVAD组的移植存活率较低(27%)，而非RVAD组的移植存活率为83%。对RVAD围术期支持的需求很低，只有11%。术前低PAP和低RV SWI是使用RVAD的显著危险因素。(C)1999年，由胸外科医生学会颁发。
Background. Implantable left ventricular assist device (LVAD) insertion complicated by early right ventricular (RV) failure has a poor prognosis and is generally unpredictable.Methods. To determine preoperative risk factors for perioperative RV failure after LVAD insertion, patient characteristics and preoperative hemodynamics were analyzed in 100 patients with the Hearth late LVAD (Thermo Cardiosystems, Inc, Woburn, MA) at the Cleveland Clinic.Results. RV assist device support was required for II patients (RVAD group). RVAD use was significantly higher in younger patients, female patients, smaller patients, and myocarditis patients. There was no significant difference in the cardiac index, RV ejection fraction, or right atrial pressure between the two groups preoperatively. The preoperative mean pulmonary arterial pressure (PAP) and RV stroke work index (RV SWI) were significantly lower in the RVAD group (p = 0.015 and p = 0.011, respectively). Survival to transplant was poor in the RVAD group (27%) and was 83% in the no-RVAD group.Conclusions. The need for perioperative RVAD support was low, only 11%. Preoperative low PAP and low RV SWI were significant risk factors for RVAD use. (C) 1999 by The Society of Thoracic Surgeons.