Outcomes of children bridged to heart transplantation with ventricular assist devices - A multi-institutional study
Outcomes of children bridged to heart transplantation with ventricular assist devices - A multi-institutional study
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DOI：
10.1161/circulationaha.105.577601
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发表时间：
2006-05-16
期刊：
影响因子：
37.8
通讯作者：
Webber, SA
中科院分区：
文献类型：
--
作者：
Blume, ED;Naftel, DC;Webber, SA
背景-目前美国的心室辅助装置（VAD）主要是为成人使用而设计的。VAD作为一个桥梁，以移植在children的数据是limited.Methods和Results-A多机构，前瞻性维护的数据库的结果，在儿童上市后心脏移植（n=2375）被用来分析结果的VAD患者（n=99，4%）列在1993年1月至2003年12月。VAD植入时的中位年龄为13.3岁（范围：2天至17.9岁）;诊断为心肌病（78%）和先天性心脏病（22%）。平均支持时间为57天（范围：1至465天）。73%的患者接受长期器械支持，39%的患者需要双心室支持。77例患者（77%）存活至移植，5例患者成功脱离支持并恢复，17例患者（17%）死于支持。在最近的时代（2000年至2003年），86%的患者使用VAD成功实现了移植桥。在等待期间死亡的最高风险是放置VAD后的前2周。等待移植期间死亡的危险因素包括早期植入（P=0.05）、女性（P=0.02）和先天性疾病诊断（P=0.05）。移植后5年生存率无差异，在移植时与那些不需要VAD. Conclusions VAD支持儿童成功桥接77%的患者移植，移植后的结果与那些不需要VAD。这些令人鼓舞的结果强调，需要进一步了解患者的选择，并划定VAD技术对儿童的影响。
Background-Current ventricular assist devices (VADs) in the United States are designed primarily for adult use. Data on VADs as a bridge to transplantation in children are limited.Methods and Results-A multi-institutional, prospectively maintained database of outcomes in children after listing for heart transplantation (n=2375) was used to analyze outcomes of VAD patients (n=99, 4%) listed between January 1993 and December 2003. Median age at VAD implantation was 13.3 years (range, 2 days to 17.9 years); diagnoses were cardiomyopathy (78%) and congenital heart disease (22%). Mean duration of support was 57 days (range, 1 to 465 days). Seventy-three percent were supported with a long-term device, with 39% requiring biventricular support. Seventy-seven patients (77%) survived to transplantation, 5 patients were successfully weaned from support and recovered, and 17 patients (17%) died on support. In the recent era (2000 to 2003), successful bridge to transplantation with VAD was achieved in 86% of patients. Peak hazard for death while waiting was the first 2 weeks after VAD placement. Risk factors for death while awaiting a transplant included earlier era of implantation (P=0.05), female gender (P=0.02), and congenital disease diagnosis (P=0.05). There was no difference in 5-year survival after transplantation for patients on VAD at time of transplantation as compared with those not requiring VAD.Conclusions-VAD support in children successfully bridged 77% of patients to transplantation, with posttransplantation outcomes comparable to those not requiring VAD. These encouraging results emphasize the need to further understand patient selection and to delineate the impact of VAD technology for children.