HeartCon型左心室辅助装置治疗成人终末期心衰的围手术期处理策略与疗效观察

Perioperative management strategy and efficacy of the left ventricular assist device HeartCon in the treatment of adult patientswithend-stage heartfailure

目的探讨HeartCon型左心室辅助装置治疗成人终末期心衰的围手术期处理策略,并评价血泵的有效性。方法连续纳入2021年7月至2023年7月在江苏省人民医院心脏大血管外科接受HeartCon型左心室辅助装置治疗的10例终末期心衰患者,对其临床资料和随访结果进行回顾性分析。评价植入左心室辅助术前、术后第30、60、90、180、360、540和720天的血泵运行情况、心功能分级、肝肾功能、凝血功能、心肌标志物、N末端B型利钠肽原(NT-proBNP)、血管性血友病因子(vWF)抗原、超声心动图、X线胸片心胸比、6 min步行距离测试(6MWT)和有无并发症,采用欧洲五维五水平生存质量量表(EQ-5D-5L)进行生活质量评分。结果10例患者中,男9例,女1例;平均(53.7±9.7)岁。所有患者术后均生存,出院后继续予以规范抗心衰药物治疗。随访中有1例因肾功能不全行血滤治疗,1例缆线处皮肤反复无菌性肉芽肿,其余无并发症发生。与术前比较,所有患者的谷草转氨酶(AST)、谷丙转氨酶(ALT)、乳酸脱氢酶(LDH)、血肌酐(Scr)、尿素氮(BUN)、右心室面积变化分数(FAC)和三尖瓣环收缩位移(TAPSE)在术后第30、60、90天变化不大,差异无统计学意义(P>0.05);NT-proBNP、vWF抗原、左心室舒张期末内径(LVDd)、心胸比在术后第30、60、90天比术前显著下降,差异有统计学意义(P<0.05);左心室射血分数(LVEF)、6MWT和EQ-5D-5L评分在术后第30、60、90天比术前显著提高,差异有统计学意义(P<0.05)。结论在HeartCon型左心室辅助装置作用下,术后3个月内患者的心功能即有显著改善,生存质量也明显提高,且未观察到严重并发症,证明设备安全有效。

Objective To discuss the perioperative management strategy of the HeartCon left ventricular assist device in the treatment of adult patients with end-stage heart failure and evaluate the effectiveness of blood pump.Methods Ten consecutive patients with end-stage heart failure treated with the LVAD HeartCon at the Department of Cardiovascular Surgery,Jiangsu Province Hospital from July 2021 to July 2023 were enrolled in this study.The clinical data and follow-up results were retrospectively analyzed.Blood pump parameter,cardiac function classification,liver and kidney function,coagulation,myocardial markers,N-terminal pro-B-type natriuretic peptide,von Willebrand factor antigen,echocardiography,cardiothoracic ratio,and 6-minute walking distance test(6MWT)were evaluated before and after implantation of LVAD in 30,60,90,180,360,540,and 720 days.EQ-5D-5L questionnaire was used to evaluate the quality of life.Results There were 9 males and 1 female with a mean age of(53.7±9.7)years.All patients survived.Renal insufficiency occurred in 1 patient and recurrent aseptic granuloma occurred in 1 patient.There were no significant differences in aspartate aminotransferase(AST),alanine aminotransferase(ALT),lactate dehydrogenase(LDH),serum creatinine(Scr),blood urea nitrogen(BUN),right ventricular fractional area change(FAC)and tricuspid annular plane systolic excursion(TAPSE)between pre-operation and 30,60 and 90 days post-operation(P>0.05).The levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP),von Willbrand factor(vWF)antigen,left ventricular end-diastolic diameter(LVDd)and cardiothoracic ratio decreased significantly on the 30th,60th and 90th day after operation(P<0.05).The left ventricular ejection fraction(LVEF),6MWT and EQ-5D-5L scores were significantly increased at 30,60 and 90 days after operation compared with those before operation(P<0.05).Conclusion With the left ventricular assist device HeartCon,the cardiac function and quality of life of patients were significantly improved within 3 months after operation,and no serious complications were observed,proving that the device is safe and effective.