Background

While preoperative hemodynamic risk factors associated with early right heart failure (RHF) following left ventricular assist device (LVAD) surgery are well-established, the relationship between postoperative hemodynamic status and subsequent outcomes remains poorly defined.

Methods

We analyzed adult CF-LVAD patients from the STS-INTERMACS registry surviving at least 3 months without evidence of early RHF and with hemodynamic data available at 3 months after LVAD implant. The association between metrics of RV afterload and function and the subsequent risk of death, right heart failure (RHF), gastrointestinal bleeding (GIB), or stroke were assessed using multivariable Cox proportional hazards modeling.

Results

Among 1,050 patients with available 3-month hemodynamics, pulmonary hypertension was common, with 585 (55.7%) having mPAP ≥ 20 mm Hg and 164 (15.6%) having PVR ≥ 3 WU. Pulmonary artery pulsatility index (PAPi, HR 0.62 per log-increase for values < 3, 95% CI 0.43-0.89) and PVR (HR 1.19 per 1 WU-increase for values > 1.5 WU, 95% CI 1.03-1.38) were independently associated with the composite of death or RHF. Postoperative RAP (HR 1.18 per 5 mm Hg increase, 95% CI 1.04-1.33), RAP:PCWP (HR 1.46 per log-increase, 95% CI 1.12-1.91), and PAPi (HR 0.76 per log-increase, 95% CI 0.61-0.95) were each associated with GIB risk. Postoperative hemodynamics was not associated with stroke risk.

Conclusions

Hemodynamic metrics of postoperative RV dysfunction and elevated RV afterload are independently associated with RHF, mortality and GIB. Whether strategies targeting postoperative optimization of RV function and afterload can reduce the burden of these adverse events requires prospective study.

中文翻译：

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肺动脉高压和右心室功能障碍的术后血流动力学指标与左心室辅助装置植入后临床结果的相关性

背景

虽然左心室辅助装置 (LVAD) 手术后与早期右心衰竭 (RHF) 相关的术前血流动力学危险因素已得到充分确立，但术后血流动力学状态与后续结果之间的关系仍不清楚。

方法

我们分析了来自 STS-INTERMACS 登记的成年 CF-LVAD 患者，这些患者在没有早期 RHF 证据的情况下存活了至少 3 个月，并且在 LVAD 植入后 3 个月可获得血流动力学数据。使用多变量 Cox 比例风险模型评估 RV 后负荷和功能指标与随后的死亡、右心衰竭 (RHF)、胃肠道出血 (GIB) 或中风风险之间的关联。

结果

在 1,050 名 3 个月血流动力学可用的患者中，肺动脉高压很常见，其中 585 名 (55.7%) 的 mPAP ≥ 20 mm Hg 和 164 名 (15.6%) 的PVR ≥ 3 WU。肺动脉搏动指数（PAPi，HR 0.62/log-increas for values < 3, 95% CI 0.43-0.89）和 PVR（HR 1.19 per 1 WU-increas for values > 1.5 WU, 95% CI 1.03-1.38）是独立的与死亡或 RHF 的复合相关。术后RAP（HR 1.18 每增加 5 mm Hg，95% CI 1.04-1.33），RAP：PCWP（HR 1.46 每增加对数，95% CI 1.12-1.91）和 PAPi（HR 0.76 每增加对数，95% CI 0.61-0.95）均与 GIB 风险相关。术后血流动力学与卒中风险无关。

结论

术后 RV 功能障碍和 RV 后负荷升高的血流动力学指标与 RHF、死亡率和 GIB 独立相关。针对RV 功能和后负荷术后优化的策略是否可以减轻这些不良事件的负担需要前瞻性研究。