Improving outcomes with long-term "destination" therapy using left ventricular assist devices
Improving outcomes with long-term "destination" therapy using left ventricular assist devices
复制标题
DOI：
10.1016/j.jtcvs.2006.09.124
复制
发表时间：
2008-06-01
影响因子：
6
通讯作者：
Renlund, Dale G.
中科院分区：
文献类型：
--
作者：
Long, James W.;Healy, Aaron H.;Renlund, Dale G.
目的：与基准的机械辅助治疗充血性心力衰竭随机评价试验相比，分析使用长期左心室辅助装置的目的地治疗经验，以评估这种突破性治疗晚期心力衰竭改善预后的潜力。方法：回顾性分析美国最大的单中心目的地治疗经验（犹他州盐湖城LDS医院犹他州人工心脏项目）。所有终点治疗接受者（n = 23）均表现为慢性晚期心力衰竭，符合机械辅助治疗充血性心力衰竭试验随机评价的终点治疗指征。所有患者都接受了HeartMate左心室辅助装置（Thoratec Corp, Pleasanton, california），其中87%的患者接受了改进的XVE模型。采用多学科方法实施高级实践指南。生存率（Kaplan-Meier， log-rank分析）和不良事件（泊松回归）与随机评价机械辅助治疗充血性心力衰竭左心室辅助装置组（n = 68）进行比较。结果：目的治疗组的生存率显著提高（P = .007），总体死亡率降低66%。目的治疗组的2年生存率为77%，而机械辅助治疗左心室辅助装置组的2年生存率为29% （P < 0.0001）。目的治疗的1年生存率为77%，而机械辅助治疗充血性心力衰竭左心室辅助装置的随机评价率为52% （P = 0.036）。不良事件减少了38%（与机械辅助治疗充血性心力衰竭的随机评价左心室辅助装置率为6.32相比，目的地治疗组为3.90例/患者年）。与疾病严重程度相关的因素均符合机械辅助治疗充血性心力衰竭的随机评价标准。结论：该分析提供的证据表明，长期目标治疗可以得到改善，远远超出了机械辅助治疗充血性心力衰竭试验的随机评估的开创性经验。随着设备、管理和患者选择的不断发展，接近心脏移植的结果是可能的。
Objective: Destination therapy experience using long-term left ventricular assist devices was analyzed relative to the benchmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial to evaluate the potential for improving outcomes with this groundbreaking therapy for advanced heart failure.Methods: The largest single-center experience with destination therapy in the United States (Utah Artificial Heart Program, LDS Hospital, Salt Lake City, UT) was retrospectively analyzed. All destination therapy recipients (n = 23) presented with chronic, advanced heart failure, meeting indications for destination therapy adopted from the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. All received HeartMate left ventricular assist devices (Thoratec Corp, Pleasanton, Calif), with 87% receiving an improved XVE model. Advanced practice guidelines were implemented using a multidisciplinary approach. Survivals (Kaplan-Meier, log-rank analyses) and adverse events (Poisson regression) were compared with those of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure left ventricular assist device group (n = 68).Results: Survival in the destination therapy group was significantly increased (P = .007), with an overall reduction in mortality of 66%. The 2-year survival was 77% for destination therapy compared with 29% for the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure left ventricular assist device group (P < .0001). The 1-year survival was 77% for destination therapy compared with the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure left ventricular assist device rate of 52% (P = .036). Adverse events decreased by 38% (3.90 per patient-year in the destination therapy group compared with the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure left ventricular assist device rate of 6.32). Factors related to severity of illness met Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure-like criteria for both groups.Conclusions: This analysis provides evidence that long-term destination therapy can be improved well beyond the pioneering experience of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure trial. With continued evolution of devices, management, and patient selection, outcomes approaching those of heart transplantation may be possible.