Cardiac recovery following left ventricular assist device therapy: experience of complete device explantation including ventricular patch plasty
Cardiac recovery following left ventricular assist device therapy: experience of complete device explantation including ventricular patch plasty
复制标题
DOI：
10.1093/ejcts/ezaa461
复制
发表时间：
2021-04-01
影响因子：
3.4
通讯作者：
Morshuis, Michiel
中科院分区：
文献类型：
--
作者：
Gyoten, Takayuki;Rojas, Sebastian, V;Morshuis, Michiel
目的：心肌恢复是左心室辅助装置（LVAD）治疗中的罕见现象。手术 LVAD 切除与心力衰竭的风险相关，对心肌充分恢复的个体评估至关重要。因此，完整的装置移植并不能始终如一地进行以最大限度地降低围手术期风险。然而，其余的心室辅助装置组件具有感染或血栓形成的显着风险。因此，我们开展这项研究来评估完整的 LVAD 外植方案。方法：我们机构中所有接受 LVAD 外植的患者均纳入本研究。外植体手术涉及去除传动系统、泵壳、缝合环和流出移植物。通过双补片成形术重建心室壁。我们的分析重点是手术和术后结果参数，包括全因死亡率和主要不良心脑血管事件。 结果：共有 12 名患者（HVAD，n = 5；HeartMate II，n = 3；HeartMate 3，n = 4）心肌恢复并符合我们的 LVAD 移植研究方案的资格 [中位年龄：40 岁，四分位距 (IQR) 33-52 岁； 50% 男性]。原发性心力衰竭病因：心肌炎（n = 5）、扩张型心肌病（n = 4）、中毒性心肌病（n = 2）和瓣膜性心力衰竭（n = 1）。 LVAD 的中位平均持续时间为 10 个月（25-75%：IQR 8.5-30 个月）。 LVAD 植入时左心室射血分数中位数为 15%（IQR 13-18%），LVAD 拔除前为 50%（IQR 45-50%）（P = 0.0025）。30 天生存率为 100%。 1年生存率为91.7%。所有患者均在术后中位 13 天（IQR 10-18 天）后出院。没有患者出现重大不良心脑血管事件。纽约心脏协会功能分级在随访期间保持一致（纽约心脏协会功能分级中位数：II，IQR II-II 级），包括心室功能的保留。结论：完全 LVAD 移出联合心室补片成形术是可行的，并且具有一致的长期结果。
OBJECTIVES: Myocardial recovery is a rare phenomenon in left ventricular assist device (LVAD) therapy. Surgical LVAD removal is associated with the risk of cardiac failure, and the individual evaluation of sufficient myocardial recovery is crucial. Thus, complete device explantation is not consistently performed to minimize perioperative risk. However, the remaining ventricular assist device components bear significant risks of infection or thrombosis. Therefore, we developed this study to evaluate a complete LVAD explantation protocol.METHODS: All patients in our institution who had an LVAD explanted were enrolled in the study. Explant surgery involved removal of the driveline, pump housing, sewing ring and outflow graft. The ventricular wall was reconstructed by double patch plasty. Our analysis focused on surgical and postoperative outcome parameters, including all-cause mortality and major adverse cardiac and cerebrovascular events.RESULTS: A total of 12 patients (HVAD, n = 5; HeartMate II, n = 3; HeartMate 3, n = 4) had myocardial recovery and qualified for our LVAD explantation study protocol [median age: 40 years, interquartile range (IQR) 33-52 years; 50% men]. Primary heart failure aetiology: myocarditis (n = 5), dilated cardiomyopathy (n = 4), toxic cardiomyopathy (n = 2) and valvular heart failure (n = 1). The median average duration on LVAD was 10 months (25-75%: IQR 8.5-30 months). The median left ventricular ejection fraction was 15% (IQR 13-18%) at LVAD implantation and 50% (IQR 45-50%) before LVAD explantation (P = 0.0025).The 30-day survival was 100%. The 1-year survival was 91.7%. All patients were discharged after a median 13 days (IQR 10-18 days) postoperatively. No patient had major adverse cardiac and cerebrovascular events. The New York Heart Association functional class remained consistent during the follow-up period (median New York Heart Association functional class: II, IQR II-II class) including preservation of ventricular function.CONCLUSIONS: Complete LVAD explantation with ventricular patch plasty is feasible and has consistent long-term results.