Use of centrifugal left ventricular assist device as a bridge to candidacy in severe heart failure with secondary pulmonary hypertension
Use of centrifugal left ventricular assist device as a bridge to candidacy in severe heart failure with secondary pulmonary hypertension
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DOI：
10.1093/ejcts/ezs678
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发表时间：
2013-06-01
影响因子：
3.4
通讯作者：
Tsui, Steven S.
中科院分区：
文献类型：
--
作者：
Kutty, Ramesh S.;Parameshwar, Jayan;Tsui, Steven S.
肺动脉压(PAP)、跨肺压差(TPG)和肺血管阻力(PVR)升高是继发性肺动脉高压(PH)患者心脏移植后预后不良的危险因素，可能是心脏移植的禁忌症。用可植入的左心室辅助装置(LVAD)卸载左心室可以逆转这些肺血管的变化。我们对2005年5月至2010年12月间植入离心式LVAD的29例患者的肺血流动力学进行了回顾，其中8例植入了心脏器皿辅助装置(HVAD)，来自美国的哈特威尔公司，21例来自澳大利亚Ventracor有限公司。17例因TPG/PVR高而不符合移植条件。所有患者均采用正性肌力/球囊反搏加左前降支置入术进行优化。四个所需的临时右VAD支持。术后30d死亡率3.4%(1/29)，1年生存率85.7%(24/28)。到目前为止，已有13名患者接受了移植：30天死亡率为7.7%(1/13)，1年生存率为91%(10/11)。VAD治疗前和治疗后肺血流动力学均有明显改善，收缩压(PAP)由57±-9.5、42+/-4.4和14+/-3.9分别降至32+/-7.5、18+/-5.5和9+/-3.3。PVR从5+/-1.5个Wood单位降至2.1+/-0.5个Wood单位(P<；0.05)。在有继发性PH的心力衰竭患者中，使用离心式LVAD可显著降低PAP、TPG和PVR，在1个月内观察到，在3个月后达到最低点。这些过渡到候选资格的患者的移植后存活率与那些接受心脏移植作为主要治疗的患者相当。
Raised pulmonary artery pressure (PAP), trans-pulmonary gradient (TPG) and pulmonary vascular resistance (PVR) are risk factors for poor outcomes after heart transplant in patients with secondary pulmonary hypertension (PH) and may contraindicate transplant. Unloading of the left ventricle with an implantable left ventricular assist device (LVAD) may reverse these pulmonary vascular changes. We studied the effect of implanting centrifugal LVADs in a cohort of patients with secondary PH as a bridge to candidacy.Pulmonary haemodynamics on patients implanted with centrifugal LVADs at a single unit between May 2005 and December 2010 were retrospectively reviewed.Twenty-nine patients were implanted with centrifugal LVADs (eight HeartWare ventricular assist device (HVAD), HeartWare International, USA and 21 VentrAssist, Ventracor Ltd., Australia). Seventeen were ineligible for transplant by virtue of high TPG/PVR. All the patients were optimized with inotrope/balloon pump followed by LVAD insertion. Four required temporary right VAD support. Thirty-day mortality post-LVAD was 3.4% (1 of 29) with a 1-year survival of 85.7% (24 of 28). Thirteen patients have been transplanted to date: 30-day mortality was 7.7% (1 of 13) and 1-year survival was 91% (10 of 11). Baseline and post-VAD pulmonary haemodynamics were significantly improved: systolic PAP (mmHg), mean PAP, TPG (mmHg) of 57 +/- 9.5, 42 +/- 4.4 and 14 +/- 3.9 reduced to 32 +/- 7.5, 18 +/- 5.5 and 9 +/- 3.3, respectively. PVR reduced from 5 +/- 1.5 to 2.1 +/- 0.5 Wood units (P < 0.05).In selected heart failure patients with secondary PH, use of centrifugal LVAD results in significant reductions in PAP, TPG and PVR, which are observed within 1 month, reaching a nadir by 3 months. Such patients bridged to candidacy have post-transplant survival comparable with those having a heart transplant as primary treatment.