国产第3代磁悬浮左心室辅助装置植入同期行二尖瓣成形术的早中期临床结果分析  

Early and mid-term outcomes of domestic third-generation magnetically levitated left ventricular assist device implantation with concomitant mitral valvuloplasty

作　　者：王志华[1] 胡俊龙[1] 刘琨 陈志高 孙俊杰[1] 王保才 刘前进 程兆云[1] WANG Zhihua;HU Junlong;LIU Kun;CHEN Zhigao;SUN junjie;WANG Baocai;LIU Qianjin;CHENG Zhaoyun(Department of Cardiac Surgery,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou,451464,China;Department of Cardiac Surgery,Cardiovascular Medical Center,the University of Hong Kong-Shenzhen Hospital)

机构地区：[1]郑州大学华中阜外医院心外科,郑州451464 [2]香港大学深圳医院心血管医学中心心外科

出　　处：《临床心血管病杂志》2023年第9期719-725,共7页Journal of Clinical Cardiology

基　　金：河南省重点研发专项项目(No:221111310300);河南省医学科技攻关计划项目(No:LHGJ20220111);河南省医学科技攻关计划项目(No:SBGJ202101005)。

摘　　要：目的:对比分析国产第3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、中期临床结果。方法:选取13例接受LVAD植入并合并术前中重度二尖瓣反流的终末期心力衰竭患者,根据是否同期行MVP分为LVAD+MVP组9例和LVAD组4例。对比分析两组患者的基线资料、手术资料和早、中期随访资料。结果:与LVAD组相比,LVAD+MVP组手术数量显著增多(P<0.01),手术时间、体外循环时间、主动脉阻断时间、术中出血量、术后呼吸机使用时间和住院时间均有所增加,ICU停留时间有所减少,但均差异无统计学意义。LVAD组1例患者术后早期死亡,两组术后早期病死率、并发症发生率比较均差异无统计学意义。术后成功随访12例患者,随访时间6~58个月,随访期间无患者死亡,NYHA心功能分级均为Ⅰ~Ⅱ级。与LVAD组相比,LVAD+MVP组术后1、3个月肺动脉收缩压均显著较低(均P<0.05)。两组术后中重度二尖瓣反流、中重度三尖瓣反流、再入院率及早中期并发症发生率比较均差异无统计学意义。结论:国产第3代磁悬浮LVAD植入同期行MVP是安全且可行的,术后早、中期血流动力学更好。同期行MVP对LVAD患者术后早、中期病死率、再入院率和并发症发生率可能无明显影响。Objective:To analyze the early and mid-term outcomes of domestic third-generation magnetically levitated left ventricular assist device(LVAD) with or without concomitant mitral valvuloplasty(MVP).Methods:A total of 13 end-stage heart failure patients who underwent LVAD implantation with pre-operative moderate to severe mitral regurgitation were included.According to whether MVP was performed concurrently or not,there were 9 patients in the LVAD+MVP group and 4 patients in the LVAD group.The baseline data,surgical data,and early and mid-term follow-up data between the two groups were compared.Results:Compared with the LVAD group,the LVAD+MVP group had significantly more concomitant surgeries(P0.01);and there were increases in operation time,cardiopulmonary bypass time,aortic cross-clamping time,blood loss,ventilator support time,and postoperative hospital stay,and decreases in ICU stay time,but none of the differences were statistically significant.One patient in the LVAD group died early after surgery,and there was no statistically significant difference in early postoperative mortality and complication incidence between the two groups.Twelve patients were followed up for 6 to 58 months.During the follow-up period,no patient died and all patients had NYHA cardiac function class Ⅰ-Ⅱ.Compared with the LVAD group,the LVAD+MVP group had significantly lower pulmonary artery systolic pressure at 1 and 3 months after surgery,with statistically significant differences(both P0.05).There was no significant difference in the incidences of moderate to severe mitral regurgitation,moderate to severe tricuspid regurgitation,readmission,and early and mid-term complications between the two groups after surgery.Conclusion:Concomitant MVP during domestic third-generation magnetically levitated LVAD implantation is safe and feasible,with better hemodynamics in the early and mid-term postoperative period,and concomitant MVP may not have a significant effect on the early and mid-term postoperative mortality,readmission rate,and co

关 键 词：心力衰竭 左心室辅助装置 二尖瓣反流 二尖瓣成形术 随访 

分 类 号：R654.2[医药卫生—外科学]