Outcomes and predictors of early mortality after continuous-flow left ventricular assist device implantation as a bridge to transplantation.
Outcomes and predictors of early mortality after continuous-flow left ventricular assist device implantation as a bridge to transplantation.
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DOI：
10.1097/mat.0000000000000035
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发表时间：
2014-03
期刊：
影响因子：
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通讯作者：
Simon AR
中科院分区：
文献类型：
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作者：
Sabashnikov A;Mohite PN;Zych B;García D;Popov AF;Weymann A;Patil NP;Hards R;Capoccia M;Wahlers T;De Robertis F;Bahrami T;Amrani M;Banner NR;Simon AR
左心室辅助装置 (LVAD) 正迅速成为晚期心力衰竭患者的标准治疗方法。然而，尽管 VAD 技术不断改进，但这一极端患者群体的术后早期发病率和死亡率仍然很高。本研究的目的是探讨植入连续流 LVAD 后患者 90 天死亡率的短期结果和预测因素。收集并回顾性比较 90 天幸存者和非幸存者的围手术期临床、超声心动图、血流动力学和实验室数据。对 90 天死亡率的单变量预测因子进行多变量逻辑回归分析，进入标准为 p < 0.1。 2006 年 7 月至 2012 年 5 月期间，117 名患者接受了连续流 LVAD 植入，作为移植的桥梁：71 名 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) 和 46 名 (39.3%) HVAD (HeartWare International, Framingham, MA)。 90 天全因死亡率为 17.1%。多变量分析显示，较高的术前中心静脉压（比值比 [OR]，1.18；95% 置信区间 [CI]，1.014–1.378；p = 0.033）和较高的年龄（OR，1.14；95% CI，1.01–1.38；p = 0.045）是 90 天死亡率的唯一独立预测因素。术前容量状态、前负荷和右心功能的优化以及基于年龄的 LVAD 支持候选人的选择是影响连续流 LVAD 植入后早期结果的关键因素。
Left ventricular assist devices (LVADs) are fast becoming standard of care for patients with advanced heart failure. However, despite continuous improvement in VAD technology, there remains a significant early postoperative morbidity and mortality in this extreme patient group. The aim of the current study was to explore the short-term outcomes and predictors for 90 day mortality in the patients after implantation of continuous-flow LVAD. Perioperative clinical, echocardiographic, hemodynamic, and laboratory data of 90 day survivors and nonsurvivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 90 day mortality with an entry criterion of p < 0.1. Between July 2006 and May 2012, 117 patients underwent implantation of a continuous-flow LVAD as a bridge to transplantation: 71 (60.7%) HeartMate II (Thoratec Corp, Pleasanton, CA) and 46 (39.3%) HVAD (HeartWare International, Framingham, MA). All-cause 90 day mortality was 17.1%. Multivariate analysis revealed higher preoperative central venous pressure (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.014–1.378; p = 0.033) and higher age (OR, 1.14; 95% CI, 1.01–1.38; p = 0.045) as the only independent predictors for 90 day mortality. Optimization of preoperative volume status, preload, and right heart function as well as age-based selection of candidates for LVAD support are the critical factors influencing early outcome after continuous-flow LVAD implantation.