Quantifying the impact from stroke during support with continuous flow ventricular assist devices: An STS INTERMACS analysis
Quantifying the impact from stroke during support with continuous flow ventricular assist devices: An STS INTERMACS analysis
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DOI：
10.1016/j.healun.2020.04.006
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发表时间：
2020-08-01
影响因子：
8.9
通讯作者：
Colombo, Paolo C.
中科院分区：
文献类型：
--
作者：
Kirklin, James K.;Naftel, David C.;Colombo, Paolo C.
导言：在植入持续流动耐久左心室辅助装置(LVAD)期间，不良事件，尤其是中风，仍然是限制非卧床型晚期心力衰竭患者更广泛应用的主要障碍。方法：2014年6月至2017年6月，在胸科外科医师协会机构间注册的机械辅助循环支持数据库中，共有9,489名患者接受了10,285例持续流动左心室辅助装置(LVAD)，随访至2018年6月。结果：在随访期内，1,515名(16%)患者发生1次或1次以上中风，缺血性和出血性病因的频率几乎相等。中风的风险在第一个月约为4%，前6个月约为9%，第一年约为14%。通过多变量风险函数分析，早期发现的主要危险因素是LVAD离心流装置和伴随的心脏手术，而在稳定期(较长期)，反复不依从性的病史与卒中事件最相关。使用调制更新模型，缺血性中风的发生，特别是出血性中风的发生是随后死亡的主要危险因素。缺血性中风后6个月存活率为70%，出血性中风后为50%。根据修正的Rankin评分判断的致残性卒中与早期有轻度或无早期残疾的卒中相比，1年和2年的存活率明显较差。结论：本研究证实了使用轴流和混合(磁力和流体动力)悬浮离心泵的前2年卒中发生率为20%。这项研究表明，在那些最初致残的中风患者中，一年和两年的死亡率显著高于非致残中风患者。为了更好地了解卒中植入后的影响以及预防和干预策略的效果，我们需要更完整的修正后的Rankin评分和卒中恢复期的生活质量数据。J心肺移植2020；39：782-794(C)2020国际心肺移植学会。版权所有。
INTRODUCTION: Adverse events, especially strokes, during the implantation of continuous flow durable left ventricular assist devices (LVADs) remain the major barriers to greater application among patients with ambulatory advanced heart failure.METHODS: Between June 2014 and June 2017, a total of 9,489 patients in the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support database received 10,285 continuous flow LVADs, with follow-up through June 2018.RESULTS: During the follow-up period, 1,515 (16%) patients suffered 1 or more strokes, with a nearly equal frequency of ischemic and hemorrhagic etiology. The risk of stroke was about 4% in the first month, 9% during the first 6 months, and 14% in the first year. By multivariable hazard function analysis, the major risk factors identified in the early phase were LVAD centrifugal flow device and concomitant cardiac surgery, whereas in the constant phase (longer term), a history of repeated non-compliance was most associated with a stroke event. Using a modulated renewal model, the occurrence of an ischemic and especially a hemorrhagic stroke dominated as risk factors for subsequent mortality. Six-month survival after an ischemic stroke was 70%, and after a hemorrhagic stroke, it was < 50%. Disabling stroke as judged by Modified Rankin Score was associated with significantly worse survival at 1 and 2 years compared with strokes with mild or no early disability.CONCLUSIONS: This study confirms the 20% incidence of stroke over the first 2 years with axial flow and hybrid (magnetic and hydrodynamic) levitated centrifugal flow pumps. This study suggests a major increase in 1- and 2-year mortality among those with an initial disabling vs non-disabling stroke. To better understand the impact of strokes after implantation and the effect of prevention and intervention strategies, we need more complete Modified Rankin Scores and quality of life data during the stroke recovery period. J Heart Lung Transplant 2020;39:782-794 (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.