Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era - Implications for patient selection
Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era - Implications for patient selection
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DOI：
10.1161/circulationaha.107.691972
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发表时间：
2007-07-31
期刊：
影响因子：
37.8
通讯作者：
Miller, Leslie W.
中科院分区：
文献类型：
--
作者：
Lietz, Katherine;Long, James W.;Miller, Leslie W.
背景-具有里程碑意义的充血性心力衰竭机械辅助治疗随机评价（REMATCH）试验首次证明，在不适合移植的终末期心力衰竭患者中，植入左心室辅助装置（LVAD）作为目标治疗（DT）可以提供比任何已知药物治疗更好的生存率上级。在本研究中，我们描述的DT后REMATCH时代在UnitedStates.Methods和Results的结果-本研究包括280例患者接受HeartMate XVE LVAD植入2001年11月和2005年12月之间。在222例有完整数据的患者中建立了LVAD植入术后住院死亡率的术前风险评分。所有患者均随访至死亡或2006年12月。LVAD植入后1年生存率为56%。LVAD手术后的住院死亡率为27%。死亡的主要原因包括败血症、右心衰竭和多器官衰竭。住院死亡率最重要的决定因素是营养不良、血液学异常、终末器官或右心室功能障碍的标志物以及缺乏正性肌力支持。根据这些预测因子计算的风险评分，将DT候选者分为低（n = 65）、中（n = 111）、高（n = 28）和极高（n = 18）风险，对应的1年生存率为81%、62%、28%和11%，结论-适当选择候选人和LVAD植入时机对于改善DT的结局至关重要。在心力衰竭的主要并发症发生之前转诊接受DT的晚期心力衰竭患者，LVAD治疗最有可能获得极好的1年生存率。
Background - The landmark Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure ( REMATCH) trial first demonstrated that implantation of left ventricular assist devices (LVADs) as destination therapy (DT) can provide survival superior to any known medical treatment in patients with end-stage heart failure who are ineligible for transplantation. In the present study, we describe outcomes of DT in the post-REMATCH era in the United States.Methods and Results - The present study included 280 patients who underwent HeartMate XVE LVAD implantation between November 2001 and December 2005. A preoperative risk score for in-hospital mortality after LVAD implantation was established in 222 patients with complete data. All patients were followed up until death or December 2006. The 1-year survival after LVAD implantation was 56%. The in-hospital mortality after LVAD surgery was 27%. The main causes of death included sepsis, right heart failure, and multiorgan failure. The most important determinants of in-hospital mortality were poor nutrition, hematological abnormalities, markers of end-organ or right ventricular dysfunction, and lack of inotropic support. Stratification of DT candidates into low (n = 65), medium (n = 111), high (n = 28), and very high (n = 18) risk on the basis of the risk score calculated from these predictors corresponded with 1-year survival rates of 81%, 62%, 28%, and 11%, respectively.Conclusions - Appropriate selection of candidates and timing of LVAD implantation are critical for improved outcomes of DT. Patients with advanced heart failure who are referred for DT before major complications of heart failure develop have the best chance of achieving an excellent 1-year survival with LVAD therapy.