Surgical approach to continuous-flow left ventricular assist device explantation: A comparison of outcomes
Surgical approach to continuous-flow left ventricular assist device explantation: A comparison of outcomes
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DOI：
10.1016/j.jtcvs.2015.08.024
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发表时间：
2016-01-01
影响因子：
6
通讯作者：
Frazier, O. H.
中科院分区：
文献类型：
--
作者：
Baldwin, Andrew C. W.;Sandoval, Elena;Frazier, O. H.
目的：已证明在选择的连续流左心室辅助装置（CF LVAD）患者中进行心室再调节和装置撤机是可行的。然而，关于与不同器械取出手术方法相关的结局知之甚少。我们研究了影响的早期和晚期outcomes.Methods手术切除的方法：我们回顾性分析了所有患者谁经历了成功的心室脱机和CF LVAD切除在我们的中心的数据。按手术入路对患者进行分层。进行描述性单变量统计、多变量回归和生存分析。通过移植、器械再植入或随访结束对患者进行审查。结果：27例患者在532 +/- 424天（范围：42-1937天）的支持后成功取出CF LVAD（25例HeartMate II，2例HeartWare）。使用了四种主要在泵材料残留程度上不同的方法：完全取出泵并进行塞式心室切开术闭合（n = 13; 48%）、泵外壳取出并结扎流入和流出移植物（n = 7; 26%）、结扎流出移植物并横断传动系统（n = 5; 19%）和单独横断传动系统（n = 2; 7%）。平均总体移植后生存期为1286 +/- 947天（范围：143-3072天）。总体事件发生时间和生存分析显示，手术入路与术后住院时间（P = .7）、卒中（P = .12）、再次手术（P = .4）或生存率（P = .12）之间无显著相关性。结论：对于接受器械治疗的患者，泵停用和移除代表了有利的结局。所有方法都是可行的，并产生类似的早期和晚期生存和临床结果。
Objective: Ventricular reconditioning and device weaning in select patients with continuous-flow left ventricular assist devices (CF LVADs) has been shown to be feasible. However, little is known regarding the outcomes associated with different surgical methods of device removal. We examined the effect of surgical explantation approach on early and late outcomes.Methods: We retrospectively reviewed data from all patients who underwent successful ventricular weaning and CF LVAD explantation at our center. Patients were stratified by surgical approach. Descriptive univariate statistics, multivariate regression, and survival analyses were performed. Patients were censored by transplant, device reimplantation, or end of follow-up.Results: Twenty-seven patients were identified who underwent successful removal of a CF LVAD (25 HeartMate II, 2 HeartWare) after 532 +/- 424 days of support (range, 42-1937 days). Four approaches were used that vary primarily in the degree of retained pump material: complete pump removal with plug ventriculotomy closure (n = 13; 48%), pump housing explant with ligation of the inflow and outflow grafts (n = 7; 26%), ligation of the outflow graft and driveline transection (n = 5; 19%), and driveline transection alone (n = 2; 7%). Mean overall postexplant survival was 1286 +/- 947 days (range, 143-3072 days). Overall time-to-event and survival analyses showed no significant association between surgical approach and postoperative length of stay (P = .7), stroke (P = .12), reoperation (P = .4), or survival (P = .12).Conclusions: For patients who receive device therapy, pump deactivation and removal represents a favorable outcome. All methods are feasible and produce similar early and late survival and clinical outcomes.