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心室辅助装置植入后左心瓣膜反流的随访研究

Follow-up study of left heart valve regurgitation after implantation of left ventricular assist device

  • 摘要:
    目的 探讨左心室辅助装置(left ventricular assist device,LVAD)植入后左心瓣膜反流情况及其对患者预后的影响。
    方法 回顾性选择2021年2月至2024年7月在复旦大学附属中山医院行磁悬浮LVAD植入术的35例心肌病患者。收集患者住院期间的临床资料,包括LVAD术前的一般资料及术后瓣膜反流情况。通过电话随访患者的生存情况,并定期行经胸心脏超声随访其左心瓣膜功能。采用Kaplan-Meier生存曲线和log-rank检验比较不同瓣膜反流程度患者的生存情况。
    结果 35例患者的平均年龄(53.9±11.1)岁,30例(85.7%)为男性,3例(8.6%)在住院期间死亡。17例(48.6%)患者术前存在二尖瓣中度及以上反流,所有患者术前主动脉瓣均为中度以下反流。术后1个月,共随访30例患者,24例(80%)为二尖瓣中度以下反流,其中11例与术前相比反流缓解;6例(20%)为二尖瓣中度及以上反流,与术前相比4例反流维持、2例反流进展;2例(6.7%)患者的主动脉瓣反流进展至中度及以上。随访时间为1.2(1.0,2.1)年,术后1年、3年生存率分别为91.4%和71.1%。生存分析结果显示,术后1个月二尖瓣中度及以上反流患者的3年生存率显著低于中度以下反流患者(66.7% vs 83.3%,P=0.046)。
    结论 大部分患者磁悬浮LVAD植入后二尖瓣反流程度改善、主动脉瓣反流无明显变化,术后1个月二尖瓣反流程度与预后相关。

     

    Abstract:
    Objective To explore the valve regurgitation status of left heart after the implantation of left ventricular assist device (LVAD) and its effect on prognosis of patients with LVAD implantation.
    Methods A total of 35 patients with cardiomyopathy who underwent magnetic levitation LVAD implantation at Zhongshan Hospital, Fudan University from February 2021 to July 2024 were retrospectively selected. Clinical data during hospitalization were collected, including preoperative basic data and postoperative valve regurgitation status. Telephone follow-ups were conducted to monitor patients’ survival status and transthoracic echocardiography was used to assess left valve function. Kaplan-Meier survival curves and log-rank test were employed to compare the survival rate of patients with different levels of valve regurgitation.
    Results The 35 patients had a mean age of (53.9±11.1) years, with 85.7% male, and 3 patients (8.6%) died during hospitalization. Preoperatively, 17 patients (48.6%) had moderate or greater mitral regurgitation, while all 35 patients had less than moderate aortic regurgitation. One month postoperatively, thirty patients were followed up, among which 24 patients (80%) had less than moderate mitral regurgitation, including 11 cases with alleviated regurgitation compared to pre-surgery; 6 patients (20%) had moderate or greater mitral regurgitation, including 4 cases with stable regurgitation and 2 cases with progression of regurgitation compared to pre-surgery; 2 patients (6.7%) had progression of aortic regurgitation to moderate or greater. The follow-up time was 1.2 (1.0, 2.1) years, with 1-year survival rate of 91.4% and 3-year survival rate of 71.1%. Survival analysis showed that the 3-year survival rate of patients with moderate or greater mitral regurgitation one month postoperatively was significantly lower than that of patients with less than moderate regurgitation (66.7% vs 83.3%, P=0.046).
    Conclusions After the implantation of magnetic levitation LVAD, most patients showed improvement in mitral regurgitation, while aortic regurgitation remained unchanged. The degree of mitral regurgitation one month postoperatively is associated with prognosis.

     

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