先前冠状动脉搭桥术后再手术左心室辅助装置置入：微创与胸骨切开入路。

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2025-03-06 DOI:10.1111/aor.14984

Masashi Kai, Junichi Shimamura, Sooyun Caroline Tavolacci, Guy Elgar, Hajime Ichikawa, Elliot Levine, David Spielvogel, Suguru Ohira

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引用次数: 0

摘要

目的：冠状动脉旁路移植术（CABG）后再手术持久左心室辅助装置（LVAD）置入具有挑战性，因为旁路移植术、大血管或右心室（RV）可能受到损伤。我们试图比较微创（LI）入路和全胸骨切开术（FS）技术在有CABG病史的患者中植入LVAD的效果。方法：2012年3月至2023年4月，29例有冠脉搭桥病史的患者行再手术LVAD植入术，FS组16例，LI组13例。LI入路包括上半胸切除术和左胸切开术，不切除右心室周围和旁路移植物。结果：FS组中位年龄为68岁，LI组中位年龄为70岁（p = 0.83）。HeartMate II仅在FS组使用（FS: 56.3% [N = 9] vs. LI: 0%），而HeartWare （FS: 31.3% [N = 5] vs. LI: 53.8% [N = 7]）和HeartMate 3 （FS: 12.5% [N = 2] vs. LI: 46.2% [N = 6]）两组均使用。所有患者均未发生搭桥术中损伤。在孤立LVAD植入组中，两组体外循环时间具有可比性（FS: 92 [68,96] min vs. LI: 82 [61,96] min, p = 0.33）。LI组严重RV衰竭需要机械支持的发生率较低（FS: 43.8% [N = 7] vs. LI: 0%, p = 0.02）。LI组住院死亡率较低（FS: 31.3% [N = 5] vs. LI: 9.1% [N = 1], p = 0.35）。1年估计生存率无显著差异（FS: 68.8%±11.6% vs. LI: 81.8%±11.6%,p = 0.85）。结论：冠状动脉搭桥术后再手术左室辅助装置的微创技术可通过减少左室衰竭来改善预后。

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Reoperative Left Ventricular Assist Device Insertion Following Previous Coronary Artery Bypass Grafting: Less Invasive Versus Sternotomy Approach.

Purpose: Reoperative durable left ventricular assist device (LVAD) insertion after coronary artery bypass grafting (CABG) is challenging due to potential injury to bypass grafts, great vessels, or the right ventricle (RV). We sought to compare the less invasive (LI) approach to the full sternotomy (FS) technique for LVAD implantation in patients with a prior history of CABG.

Methods: From March 2012 to April 2023, 29 patients with a history of CABG underwent reoperative LVAD implantation: Group FS, N = 16, and Group LI, N = 13. The LI approach includes an upper hemisternotomy and left thoracotomy without dissecting around the RV and bypass grafts.

Results: The median age was 68 years in Group FS and 70 years in Group LI (p = 0.83). HeartMate II was only used in group FS (FS: 56.3% [N = 9] vs. LI: 0%), whereas HeartWare (FS: 31.3% [N = 5] vs. LI: 53.8% [N = 7]) and Heartmate 3 (FS: 12.5% [N = 2] vs. LI: 46.2% [N = 6]) were used in both groups. None of the patients experienced intraoperative injury of bypass grafts. In isolated LVAD implantation, cardiopulmonary bypass time was comparable between groups (FS: 92 [68, 96] min vs. LI: 82 [61, 96] min, p = 0.33). The incidence of severe RV failure requiring mechanical support was lower in Group LI (FS: 43.8% [N = 7] vs. LI: 0%, p = 0.02). Hospital mortality was numerically lower in the LI group (FS: 31.3% [N = 5] vs. LI: 9.1% [N = 1], p = 0.35). One-year estimated survival rates were not significantly different (FS: 68.8% ± 11.6% vs. LI: 81.8% ± 11.6%, p = 0.85).

Conclusions: The less invasive technique for reoperative LVAD insertion after CABG may improve outcomes by reducing RV failure.

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.