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手术前的右心室功能障碍和心室节律失常对左心室辅助器件结果的影响
Douglas Hall1, Rahul A Chhana2, Bin Q Yang3
1From the Division of Cardiology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, Missouri.
概括
在左心室辅助装置 (LVAD) 植入之前患有临床显著心室节律失常 (VA) 的患者面临更高的死亡率,特别是那些同时存在右心室功能障碍 (RVD) 患者. 这突显了RVD作为影响LVAD结果的关键因素.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 医疗器械 医疗器械
背景情况:
- 在被考虑使用左心室辅助器件 (LVAD) 的患者中,心室节律失常 (VA) 很普遍.
- 同时存在的右心室功能障碍 (RVD) 对LVAD植入后的结果的影响仍然不清楚.
- 了解这些因素对于优化患者选择和管理至关重要.
研究的目的:
- 研究LVAD植入前VA负担和RVD对LVAD植入后死亡率和其他不良事件的影响.
- 为了确定特定的患者亚组,对不良结果的风险更高.
主要方法:
- 在2005年至2021年期间,对761名接受LVAD植入的患者进行了回顾性队列研究.
- 患者被分为没有VA,低负担VA (LBVA) 和临床显著VA (CSVA) 组.
- 使用基线心声学评估右心室功能;时间到事件分析评估死亡率,ICD冲击,再住院和RV失败并发症.
主要成果:
- 患有CSVA和基线RVD的患者表现出明显更高的死亡率 (HR=1.6,CI=1.1-2.5).
- 临床显著的VA和功能障碍独立与死亡率增加有关.
- 在LBVA和CSVA组中,植入式心脏转换器-除器冲击更频繁;在6个月的再住院治疗中没有显著差异.
结论:
- 史上的CSVA增加了LVAD接受者的死亡风险.
- 伴并发性RVD的存在显著加剧了CSVA患者的死亡风险.
- 对于LVAD候选人的风险分层应该考虑VA史和VR功能.
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