Abstract

Objectives: Development of right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation remains a leading cause of perioperative morbidity, end-organ dysfunction and mortality. The objective of this study was to investigate whether the etiology of HF (ischemic HF versus non-ischemic HF) affects the risk of RVF within admission for LVAD implantation and during long-term follow-up. Methods: Between January 2011 and June 27, 2018, 3536 patients were prospectively enrolled into EUROMACS registry. Adult patients (>18 years) who received a first time LVAD were included. When excluding patients with congenital, restrictive, hypertrophic, valvular cardiomyopathies, and myocarditis the total population consisted of 2404 patients. Results: The total cohort consists of 2404 patients. Mean age were 55 years and predominantly male sex [2024 (84.2%)]. At the time of LVAD implantation 1355 (56.4%) patients had ischemic HF and 1049 (43.6%) patients had non-ischemic HF. The incidence of RVF was significantly increased in the non-ischemic HF group in the adjusted model (p = .026). The relative risk difference for RVF in patients with non-ischemic HF was in the adjusted model increased by an absolute value of 5.1% (95% CI: 0.61–9.6). In the ischemic HF group 76 patients (13.4%) developed late RVF and 62 patients (14.8%) in the non-ischemic HF group (p = .56). No differences in occurrence of RVF between HF etiology was observed after 2 and 4 years of follow-up, respectively (crude: p = .25, adjusted (sex and age) p = .2 and crude: p = .59, adjusted (sex and age) p = .44). Conclusions: Patients with non-ischemic HF undergoing LVAD had an increased incidence of early RVF compared to patients with ischemic HF in a large European population. During follow-up after discharge 14% patients developed RVF. We recommend HF etiology to be considered in identifying patients who are at risk for postoperative RVF after LVAD implantation.

摘要

目的：植入左室辅助装置（LVAD）后发生右室衰竭（RVF）仍是围手术期发病率，终末器官功能障碍和死亡率的主要原因。这项研究的目的是调查HF的病因（缺血性HF与非缺血性HF）是否会影响LVAD植入入院时以及长期随访期间RVF的风险。方法： 2011年1月至2018年6月27日，前瞻性地将3536例患者纳入EUROMACS登记册。包括首次接受LVAD的成年患者（> 18岁）。当排除患有先天性，限制性，肥厚性，瓣膜型心肌病和心肌炎的患者时，总人口为2404名患者。结果：总队列包括2404名患者。平均年龄为55岁，主要为男性[2024（84.2％）]。LVAD植入时，有1355名患者（56.4％）有缺血性HF，有1049名患者（43.6％）有非缺血性HF。在调整后的模型中，非缺血性HF组的RVF发生率显着增加（p  = .026）。在调整后的模型中，非缺血性HF患者RVF的相对风险差异增加了5.1％的绝对值（95％CI：0.61-9.6）。在缺血性HF组中，有76例患者（占13.4％）发展为晚期RVF，在非缺血性HF组中有62例患者（占14.8％）（p  = 0.56）。分别在随访2年和4年后，在HF病因之间没有观察到RVF发生的差异（粗略：p = .25，调整后的（性别和年龄）p  = 0.2，而原油：p  = .59，调整后的（性别和年龄）p  = 0.44）。结论：与欧洲大量人群缺血性HF患者相比，接受LVAD的非缺血性HF患者的早期RVF发生率增加。在出院后的随访中，有14％的患者出现RVF。我们建议在确定LVAD植入后有术后RVF风险的患者时应考虑HF病因。