摘要
目的比较国产第三代磁悬浮左心室辅助装置(left ventricular assist device,LVAD)植入是否同期行二尖瓣成形术(mitral valvuloplasty,MVP)的早期临床结果。方法纳入2018年5月—2023年3月于阜外华中心血管病医院行LVAD植入合并术前中重度二尖瓣反流(mitral regurgitation,MR)的17例终末期心力衰竭患者。根据是否同期行MVP将患者分为LVAD组和LVAD+MVP组,比较两组患者早期临床结果。结果LVAD组4例,均为男性,年龄(43.5±5.9)岁;LVAD+MVP组13例,其中男10例、女3例,年龄(46.8±16.7)岁。同期行MVP手术均成功,术后早期无MR复发。与LVAD组相比,LVAD+MVP组术后72 h肺动脉收缩压、平均肺动脉压明显较低,但差异无统计学意义(P>0.05);术后1周肺动脉收缩压、术后1个月肺动脉收缩压及平均肺动脉压显著较低,差异有统计学意义(P<0.01)。两组术中出血量、手术时间、体外循环时间、主动脉阻断时间、机械通气时间、ICU停留时间差异均无统计学意义(P>0.05);两组术后1个月死亡率、急性肾损伤、二次开胸、消化道出血及血栓栓塞等并发症差异均无统计学意义(P>0.05)。结论国产第三代磁悬浮LVAD植入同期行MVP安全可行,可能会改善术后血流动力学,没有显著增加围手术期死亡率和并发症发生率。
Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device(LVAD)with or without concomitant mitral valvuloplasty(MVP).Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed.The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously,and early outcomes were compared between the two groups.Results There were 4 patients in the LVAD group,all males,aged(43.5±5.9)years,and 13 patients in the LVAD+MVP group,including 10 males and 3 females,aged(46.8±16.7)years.All the patients were successful in concomitant MVP without mitral reguragitation occurrence.Compared with the LVAD group,the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation,but the difference was not statistically different(P>0.05).Pulmonary artery systolic pressure was significantly lower 1 week after operation,as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation(P<0.01).There was no statistically significant difference in blood loss,operation time,cardiopulmonary bypass time,aortic cross-clamping time,mechanical ventilation time,or ICU stay time between the two groups(P>0.05).The differences in 1-month postoperative mortality,acute kidney injury,reoperation,gastrointestinal bleeding,and thrombosis and other complications between the two groups were not statistically significant(P>0.05).Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible,and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.
作者
王志华
赵泽原
胡俊龙
孙俊杰
刘琨
段晓夏
王圣
程兆云
WANG Zhihua;ZHAO Zeyuan;HU Junlong;SUN Junjie;LIU Kun;DUAN Xiaoxia;WANG Sheng;CHENG Zhaoyun(Department of Cardiac Surgery,Zhengzhou University Affiliated Fuwai Central China Cardiovascular Hospital,Zhengzhou,451464,P.R.China;Department of Cardiac Surgery,Cardiovascular Medical Center,the University of Hong Kong-Shenzhen Hospital,Shenzhen,518053,Guangdong,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2024年第11期1599-1605,共7页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
社会公益研究专项计划(221111310300)
河南省医学科技公关计划项目(LHGJ20220111)
河南省医学科技公关计划项目(SBGJ202101005)。
关键词
心力衰竭
左心室辅助装置
二尖瓣反流
二尖瓣成形
早期结果
Heart failure
left ventricular assist device
mitral regurgitation
mitral valvuloplasty
early outcomes
