Patient survival and therapeutic outcome in the UK bridge to transplant left ventricular assist device population
Patient survival and therapeutic outcome in the UK bridge to transplant left ventricular assist device population
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DOI：
10.1136/heartjnl-2018-313355
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发表时间：
2019-02-01
期刊：
影响因子：
5.7
通讯作者：
Banner, Nicholas Robert
中科院分区：
文献类型：
--
作者：
Parameshwar, Jayan;Hogg, Rachel;Banner, Nicholas Robert
目的研究植入式左心室辅助装置（LVAD）作为心脏移植桥梁的英国患者的生存和预后。方法从2015年11月的英国心室辅助装置（VAD）数据库中提取2007年1月至2013年12月31日期间接受HeartMate II或HVAD作为首个长期LVAD的所有成年患者（n=342）的数据。分析的结果包括LVAD的生存、紧急上市时间、心脏移植和并发症（包括需要泵交换的并发症）。结果112例患者使用Thoratec HeartMate II， 230例患者使用HeartWare HVAD。中位支持持续时间为534天。在研究期间，81名患者需要转移到英国紧急等待心脏移植。在342例患者中，85例（24.8%）接受了心脏移植，其中63例在紧急名单上。30天生存率为88.9%，而LVAD植入后3年的总生存率为49.6%。156例患者（46%）在LVAD支持期间死亡；VAD最常见的死亡原因是脑血管意外。两种设备在任何结果上都没有显著差异。结论：在预后非常差的晚期心力衰竭患者中，植入式左心室辅助装置的支持使四分之一的患者在3年内接受心脏移植。该队列的总生存率约为50%。随着技术的进步和lvad后的管理，结果可能会进一步改善。
Objective To study the survival and patient outcome in a population of UK patients supported by an implantable left ventricular assist device (LVAD) as a bridge to heart transplantation. Methods Data on all adult patients (n=342) who received a HeartMate II or HVAD as a first long-term LVAD between January 2007 and 31 December 2013 were extracted from the UK Ventricular Assist Device (VAD) Database in November 2015. Outcomes analysed include survival on a LVAD, time to urgent listing, heart transplantation and complications including those needing a pump exchange. Results 112 patients were supported with the Thoratec HeartMate II and 230 were supported with the HeartWare HVAD. Median duration of support was 534 days. During the study period, 81 patients required moving to the UK urgent waiting list for heart transplantation. Of the 342 patients, 85 (24.8%) received a heart transplant, this included 63 on the urgent list. Thirty-day survival was 88.9%, while overall patient survival at 3 years from LVAD implant was 49.6%. 156 patients (46%) died during LVAD support; the most common cause of death on a VAD was a cerebrovascular accident. There was no significant difference between the two devices used in any outcome. Conclusions In a population of patients with advanced heart failure, who have a very poor prognosis, support with an implantable LVAD allowed a quarter to receive a heart transplant in a 3-year period. Overall survival of the cohort was about 50%. With improvement in technology and in post-LVAD management, it is likely that outcomes will improve further.