Implantable left ventricular assist device for treatment of pulmonary hypertension in candidates for orthotopic heart transplantation - a preliminary study
Implantable left ventricular assist device for treatment of pulmonary hypertension in candidates for orthotopic heart transplantation - a preliminary study
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DOI：
10.1016/j.ejcts.2004.01.052
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发表时间：
2004-06-01
影响因子：
3.4
通讯作者：
Beyersdorf, F
中科院分区：
文献类型：
--
作者：
Martin, J;Siegenthaler, MP;Beyersdorf, F
目的：肺血管阻力升高（PVR）对药物干预无反应是心脏移植（HTX）的主要限制。这些患者的术后病程与危及生命的右心衰风险增加有关。我们评估了植入式左心室辅助装置（LVAD）通过卸载左心室来降低PVR的效率，并降低后来原位HTX的风险。方法：对6例终末期心力衰竭（NYHA IV级）和“固定”肺动脉高压（PVR 5.7 +/- 0.7，范围4.4-6.5 Wood units）患者进行分析。尽管在最初评估时进行了最大程度的药物干预（吸氧、硝酸盐、前列地尔输注），PVR仍无法降至2.5 Wood单位以下。4名患者接受TCI心脏伴侣，1名患者接受Novacor， 1名患者接受Jarvik 2000。结果：所有患者均成功植入LVAD， 4例出院。术后早期心脏指数和肺动脉压恢复正常。在平均支持时间为191 +/- 86天后，PVR降至2.0 +/- 1.2（范围0.8-3.6）木单位。所有患者均可桥接移植，1例患者在移植后3个月死亡，5例患者在平均随访16.2 +/- 10.5个月后仍存活。结论：在HTX前治疗终末期心力衰竭患者重度肺动脉高压时，使用植入式LVAD机械支持是一种非常有效且风险可接受的方法。随后的HTX与良好的结果相关。(C) 2004 Elsevier B.V.版权所有
Objectives: Elevated pulmonary vascular resistance (PVR) unresponsive to pharmacological intervention is a major limitation in heart transplantation (HTX). The post-operative course of these patients is associated with an increased risk of life-threatening right heart failure. We evaluated the efficiency of an implantable left ventricular assist device (LVAD) to decrease PVR by unloading the left ventricle and to lower the risk of later orthotopic HTX. Methods: Six patients with end-stage heart failure (NYHA class IV) and 'fixed' pulmonary hypertension (PVR 5.7 +/- 0.7, range 4.4-6.5 Wood units) were analyzed. Despite maximal pharmacological intervention at initial evaluation (oxygen inhalation, nitrates, alprostadil infusion) PVR could not be reduced to under 2.5 Wood units. Four patients received a TCI Heartmate, one patient a Novacor, and one patient a Jarvik 2000. Results: All patients survived the LVAD implantation, four patients could be discharged from hospital. Cardiac index and pulmonary artery pressure values returned to normal during the early post-operative phase. After a mean support time of 191 +/- 86 days PVR had fallen to 2.0 +/- 1.2 (range 0.8-3.6) Wood units. All patients could be bridged to transplantation, one patient died 3 months after transplant, five patients are still alive after a mean follow-up of 16.2 +/- 10.5 months. Conclusions: Mechanical support using an implantable LVAD is a very efficient approach with an acceptable risk to treat severe pulmonary hypertension in end-stage heart failure patients before HTX Adequate reduction of PVR can be expected within 3-6 months. Subsequent HTX is associated with a good outcome. (C) 2004 Elsevier B.V. All rights reserved.