Sex-Related Differences in Use and Outcomes of Left Ventricular Assist Devices as Bridge to Transplantation
Sex-Related Differences in Use and Outcomes of Left Ventricular Assist Devices as Bridge to Transplantation
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DOI：
10.1016/j.jchf.2019.01.008
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发表时间：
2019-03-01
影响因子：
13
通讯作者：
Topkara, Veli K.
中科院分区：
文献类型：
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作者：
DeFilippis, Ersilia M.;Truby, Lauren K.;Topkara, Veli K.
本研究使用器官共享联合网络登记处（United Network for Organ Sharing registry.Background），在等待心脏移植的个体中，检查了连续流左心室辅助装置（CF-LVAD）的使用和结局的性别相关差异，包括CF-LVAD在内的心力衰竭高级治疗在女性中仍未得到充分使用。关于性别特异性结局，存在相互矛盾的结果。许多研究受到样本量小或包括脉动流devies.METHODS去识别患者水平的数据来自器官共享联合网络数据库的限制。查询数据库，以确定2008年至2018年期间需要使用HeartWare HVAD（Medtronic，Minneapolis，Minnesota）、HeartMate II（Abbott，Lake海崖，Illinois）或HeartMate 3（Abbott）作为心脏移植桥梁的机械循环支持的成人患者（≥ 18岁）。为每例患者分配一个倾向评分。主要结果是移植率和死亡率。结果在研究期间，共有13，305名患者（2，771名女性，20.8%）接受了CF-LVAD的支持。在已收载患者中，CF-LVAD的使用存在显著的性别差异（2017年，男性29.9%，女性18.9%）。接受CF-LVAD支持的女性患者在植入后2年时心脏移植的机会较低（55.1% vs. 67.5%），等待死亡的风险增加（7.0% vs. 4.2%），因临床状态恶化而被除名（8.5% vs. 4.7%）（所有p < 0.001）。调整设备类型后，性别仍然是等待名单死亡率的重要预测因素（风险比：1.51; p < 0.001）。当与相似的男性对照组相匹配时，女性的死亡率更高，心脏移植率更低。(C)2019年由美国心脏病学会基金会。
OBJECTIVES This study examined sex-related differences in use and outcomes of continuous-flow left ventricular assist devices (CF-LVADs) among individuals awaiting heart transplantation using the United Network for Organ Sharing registry.BACKGROUND Advanced therapies for heart failure including CF-LVADs remain underused in women. There have been contradictory results regarding sex-specific outcomes. Many studies have been limited by small sample sizes or included pulsatile-flow devices.METHODS De-identified patient-level data were obtained from the United Network for Organ Sharing database. The database was queried to identify adult patients (>= 18 years of age) who required mechanical circulatory support with HeartWare HVAD (Medtronic, Minneapolis, Minnesota), HeartMate II (Abbott, Lake Bluff, Illinois), or HeartMate 3 (Abbott) as bridge to heart transplantation between 2008 and 2018. Each patient was assigned a propensity score. The primary outcomes of interest were rates of transplantation and death.RESULTS A total of 13,305 patients (2,771 women, 20.8%) received support with CF-LVAD in the study period. There were significant sex disparities in CF-LVAD use in listed patients (29.9% men vs. 18.9% women in 2017). Female patients receiving CF-LVAD support had lower chances of heart transplantation (55.1% vs. 67.5%), increased risk of waitlist mortality (7.0% vs. 4.2%), and delisting for worsening clinical status (8.5% vs. 4.7%) at 2 years post-implantation (all p < 0.001). After adjusting for device type, sex was still a significant predictor of waitlist mortality (hazard ratio: 1.51; p < 0.001).CONCLUSIONS Durable mechanical circulatory support with CF-LVADs remains underused in women. When matched with similar male control subjects, women experienced higher mortality and lower rates of heart transplantation. (C) 2019 by the American College of Cardiology Foundation.