Journal of cardiothoracic and vascular anesthesia · 2022
Prevalence and Severity of Aortic Regurgitation Due to a Percutaneous Left Ventricular Assist Device (Impella 5.0): A Retrospective Observational Study.
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Hotta Naoshi, Tsukinaga Akito, Yoshitani Kenji, Fukushima Satsuki, Ohnishi Yoshihiko
Аннотация
OBJECTIVES: Placement of the Impella 5.0 percutaneous left ventricular assist device may cause aortic regurgitation (AR) due to malcoaptation of the aortic leaflets. The authors investigated the prevalence and severity of AR during Impella 5.0 support.
DESIGN: Retrospective observational study.
SETTING: An academic hospital.
PARTICIPANTS: A total of forty-two consecutive patients who underwent Impella 5.0 implantation from April 2018 to March 2022.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: To investigate AR prevalence, the authors calculated the AR volume by subtracting left ventricular inflow from left-sided systemic flow, the latter of which consisted of flow through the Impella 5.0 cannula and across the aortic valve. Because it is challenging to estimate flow across the aortic valve as distinct from that through Impella 5.0, the authors analyzed 19 of 42 patients whose aortic valves were closed (ie, those with no spontaneous cardiac output). AR due to Impella 5.0 was considered present if the AR fraction was ≥7%. The median AR volume was 0.6 L/min (interquartile range: 0.4-1.5 L/min), which was 13.5% (interquartile range: 11.0 to 30.6%) of the median Impella 5.0 flow. Seventeen of the 19 patients (89.5%) were diagnosed with AR during Impella 5.0 support, and the severity of AR was mild in 11 patients (57.9%) and moderate in 6 (31.6%).
CONCLUSIONS: The authors revealed a high prevalence of AR during Impella 5.0 support in patients with no spontaneous cardiac output. Moreover, 31.6% of patients had moderate AR.
DESIGN: Retrospective observational study.
SETTING: An academic hospital.
PARTICIPANTS: A total of forty-two consecutive patients who underwent Impella 5.0 implantation from April 2018 to March 2022.
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: To investigate AR prevalence, the authors calculated the AR volume by subtracting left ventricular inflow from left-sided systemic flow, the latter of which consisted of flow through the Impella 5.0 cannula and across the aortic valve. Because it is challenging to estimate flow across the aortic valve as distinct from that through Impella 5.0, the authors analyzed 19 of 42 patients whose aortic valves were closed (ie, those with no spontaneous cardiac output). AR due to Impella 5.0 was considered present if the AR fraction was ≥7%. The median AR volume was 0.6 L/min (interquartile range: 0.4-1.5 L/min), which was 13.5% (interquartile range: 11.0 to 30.6%) of the median Impella 5.0 flow. Seventeen of the 19 patients (89.5%) were diagnosed with AR during Impella 5.0 support, and the severity of AR was mild in 11 patients (57.9%) and moderate in 6 (31.6%).
CONCLUSIONS: The authors revealed a high prevalence of AR during Impella 5.0 support in patients with no spontaneous cardiac output. Moreover, 31.6% of patients had moderate AR.