Myocardial recovery using ventricular assist devices - Prevalence, clinical characteristics, and outcomes
Myocardial recovery using ventricular assist devices - Prevalence, clinical characteristics, and outcomes
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DOI：
10.1161/circulationaha.104.524124
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发表时间：
2005-08-30
期刊：
影响因子：
37.8
通讯作者：
McNamara, DM
中科院分区：
文献类型：
--
作者：
Simon, MA;Kormos, RL;McNamara, DM
心室辅助装置（vad）是心脏移植的重要桥梁。VAD支持也可以作为心室恢复（BTR）的桥梁；然而，临床预测恢复和长期结果仍然不确定。我们在一个大型单中心系列研究中检查了BTR受试者的患病率、特征和结果。方法与结果：1996年至2003年，我们在匹兹堡大学为154名成人植入了vad。其中10例为BTR植入物。其中包括2/80（2.5%）缺血性患者（分别支持42天和61天）。两名患者均行手术血运重建术，需要围手术期左VAD支持，随访时存活且无移植（分别为232天和1319天）。较大比例的非缺血性患者接受BTR（8/ 74,11 %；年龄30 +/- 14岁；88%女性；左室射血分数18 +/- 6%；支持112 +/- 76天）。心肌炎3例，产后心肌病4例，特发性心肌病1例。5例接受双心室支持。移植后，2例PPCM患者的心室功能下降，随后需要移植。6例无移植存活的非缺血性患者的心室恢复得以维持（左心室射血分数54±5%；随访1.5±0.9年）。总体而言，10例BTR患者中有8例存活且未移植（随访1.6 +/- 1.1年）。结论：在一项大型单中心研究中，11%的非缺血性患者出现明显的BTR，双心室支持的需要并不妨碍康复。对于大多数以急性炎症性心肌病为表现的BTR受试者，心室恢复长期维持。在急性心肌炎和PPCM的治疗中应考虑VAD支持作为BTR。
Background-Ventricular assist devices (VADs) are important bridges to cardiac transplantation. VAD support may also function as a bridge to ventricular recovery (BTR); however, clinical predictors of recovery and long-term outcomes remain uncertain. We examined the prevalence, characteristics, and outcomes of BTR subjects in a large single center series.Methods and Results-We implanted VADs in 154 adults at the University of Pittsburgh from 1996 through 2003. Of these implants, 10 were BTR. This included 2/80 (2.5%) ischemic patients (supported 42 and 61 days, respectively). Both subjects had surgical revascularization, required perioperative left VAD support, and were alive and transplant-free at follow up (232 and 1319 days, respectively). A larger percentage of nonischemic patients underwent BTR (8/74, 11 %; age 30 +/- 14; 88% female; left ventricular ejection fraction 18 +/- 6%; supported 112 +/- 76 days). Three had myocarditis, 4 had post-partum cardiomyopathy (PPCM), and 1 had idiopathic cardiomyopathy. Five received biventricular support. After explantation, ventricular function declined in 2 PPCM patients who then required transplantation. Ventricular recovery in the 6 nonischemic patients surviving transplant-free was maintained (left ventricular ejection fraction 54 +/- 5%; follow-up 1.5 +/- 0.9 years). Overall, 8 of 10 BTR patients are alive and free of transplant (follow-up 1.6 +/- 1.1 years).Conclusions-In a large single center series, BTR was evident in 11% of nonischemic patients, and the need for biventricular support did not preclude recovery. For most BTR subjects presenting with acute inflammatory cardiomyopathy, ventricular recovery was maintained long-term. VAD support as BTR should be considered in the care of acute myocarditis and PPCM.