Extended Mechanical Circulatory Support With a Continuous-Flow Rotary Left Ventricular Assist Device
Extended Mechanical Circulatory Support With a Continuous-Flow Rotary Left Ventricular Assist Device
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DOI：
10.1016/j.jacc.2009.03.055
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发表时间：
2009-07-21
影响因子：
24
通讯作者：
Frazier, O. Howard
中科院分区：
文献类型：
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作者：
Pagani, Francis D.;Miller, Leslie W.;Frazier, O. Howard
ObjectivesThis study seemed to evaluate the use of a continuous-flow rotary left ventricular assist device（LVAD）as a bridge to heart transplantation.BackgroundLVAD therapy is an established treatment modality for patients with advanced heart failure.脉动式LVAD在设计上有局限性，无法用于扩展支持。连续流旋转LVAD代表了一种创新的设计，具有潜在的小尺寸和更大的可靠性，通过简化的pumping mechanism.MethodsIn前瞻性，多中心研究，281例患者紧急上市（联合网络的器官共享状态1A或1B）心脏移植进行植入的连续流LVAD。在18个月时评估存活率和移植率。在整个研究中，对患者的不良事件和生活质量，功能状态和器官功能进行了评估6 months.ResultsOf 281例患者，222（79%）进行移植，LVAD去除心脏恢复，或正在进行LVAD支持在18个月的随访。18个月时，支持的精算生存率为72%（95%置信区间：65%至79%）。在6个月时，功能状态和6分钟步行试验（纽约心脏协会功能I级或II级的患者从0%到83%，完成6分钟步行试验的患者从13%到89%）和生活质量（明尼苏达心力衰竭患者的平均值提高了41%，堪萨斯城心肌病问卷的平均值提高了75%）均有显著改善。主要不良事件包括出血、卒中、右心衰竭和经皮电极导线感染。泵血栓发生在4 patients.ConclusionsA连续流LVAD提供有效的血流动力学支持至少18个月的患者等待移植，改善功能状态和生活质量。（Thoratec HeartMate II左心室辅助系统[LVAS]用于心脏移植的桥接; NCT 00121472）（J Am科尔心脏病学杂志2009; 54：312-21）（C）2009年美国心脏病学会基金会
ObjectivesThis study sought to evaluate the use of a continuous-flow rotary left ventricular assist device (LVAD) as a bridge to heart transplantation.BackgroundLVAD therapy is an established treatment modality for patients with advanced heart failure. Pulsatile LVADs have limitations in design precluding their use for extended support. Continuous-flow rotary LVADs represent an innovative design with potential for small size and greater reliability by simplification of the pumping mechanism.MethodsIn a prospective, multicenter study, 281 patients urgently listed (United Network of Organ Sharing status 1A or 1B) for heart transplantation underwent implantation of a continuous-flow LVAD. Survival and transplantation rates were assessed at 18 months. Patients were assessed for adverse events throughout the study and for quality of life, functional status, and organ function for 6 months.ResultsOf 281 patients, 222 (79%) underwent transplantation, LVAD removal for cardiac recovery, or had ongoing LVAD support at 18-month follow-up. Actuarial survival on support was 72% (95% confidence interval: 65% to 79%) at 18 months. At 6 months, there were significant improvements in functional status and 6-min walk test (from 0% to 83% of patients in New York Heart Association functional class I or II and from 13% to 89% of patients completing a 6-min walk test) and in quality of life (mean values improved 41% with Minnesota Living With Heart Failure and 75% with Kansas City Cardiomyopathy questionnaires). Major adverse events included bleeding, stroke, right heart failure, and percutaneous lead infection. Pump thrombosis occurred in 4 patients.ConclusionsA continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplantation, with improved functional status and quality of life. (Thoratec HeartMate II Left Ventricular Assist System [LVAS] for Bridge to Cardiac Transplantation; NCT00121472) (J Am Coll Cardiol 2009; 54: 312-21) (C) 2009 by the American College of Cardiology Foundation