Pulmonary artery pulsatility index predicts prolonged inotrope/pulmonary vasodilator use after implantation of continuous flow left ventricular assist device

被引：9

作者：

Aggarwal, Varun ^{[1
,2
]}

Tume, Sebastian C. ^{[3
]}

Rodriguez, Marco ^{[1
]}

Adachi, Iki ^{[4
]}

Cabrera, Antonio G. ^{[1
]}

Tunuguntla, Hari ^{[1
]}

Qureshi, Athar M. ^{[1
]}

机构：

[1] Texas Childrens Hosp, Baylor Coll Med, Lillie Frank Abercrombie Sect Pediat Cardiol, Dept Pediat, Houston, TX 77030 USA

[2] Univ Minnesota, Dept Pediat, Div Pediat Cardiol, Masonic Childrens Hosp, Minneapolis, MN 55455 USA

[3] Texas Childrens Hosp, Baylor Coll Med, Sect Crit Care Med, Dept Pediat, 6621 Fannin St, Houston, TX 77030 USA

[4] Texas Childrens Hosp, Baylor Coll Med, Div Congenital Heart Surg, Dept Surg, Houston, TX 77030 USA

来源：

CONGENITAL HEART DISEASE | 2019年 / 14卷 / 06期

关键词：

cardiac catheterization; cardiac filling pressure; continuous flow ventricular assist device; hemodynamics; pulmonary artery pulsatility index; right ventricular dysfunction; MECHANICAL CIRCULATORY SUPPORT; INTERAGENCY REGISTRY; NATRIURETIC PEPTIDE; HEART-FAILURE; DYSFUNCTION; RECIPIENTS;

D O I：

10.1111/chd.12860

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective Predictors of right ventricle (RV) dysfunction after continuous-flow left ventricular assist device (CF-LVAD) implantation in children are not well described. We explored the association of preimplantation Pulmonary Artery Pulsatility index (PAPi) and other hemodynamic parameters as predictors of prolonged postoperative inotropes/pulmonary vasodilator use after CF-LVAD implantation. Design Retrospective chart review. Setting Single tertiary care pediatric referral center. Patients Patients who underwent CF-LVAD implantation from January 2012 to October 2017. Interventions Preimplantation invasive hemodynamic parameters were analyzed to evaluate the association with post-CF-LVAD need for prolonged (>72 hours) use of inotropes/pulmonary vasodilators. Measurements and main results Preimplantation cardiac catheterization data was available for 12 of 44 patients who underwent CF-LVAD implant during the study period. Median (IQR) age and BSA of the cohort were 15.3 years (10.2, 18) and 1.74 m(2) (0.98, 2.03). Group 1 (n = 6) included patients with need for prolonged inotropes/pulmonary vasodilator use after CF-LVAD implantation and Group 2 (n = 6) included those without. Baseline demographic parameters, cardiopulmonary bypass time, and markers of RV afterload (pulmonary vascular resistance, PA compliance and elastance) were similar among the two groups. PAPi was significantly lower in group 1 compared to group 2 (0.96 vs 3.6, respectively; P = .004). Post-LVAD stay in the intensive care unit was longer for patients in group 1 (46 vs 23 days, P = .52). Brain natriuretic peptide was significantly higher at 3 months after implantation in group 1; P = .01. Conclusions The need for inotropes/pulmonary vasodilators in the postoperative period can be predicted by the preimplantation intrinsic RV contractile reserve as assessed by PAPi rather than the markers of RV afterload. Further investigation and correlation with clinical outcomes is needed.

引用

页码：1130 / 1137

页数：8