Impact of bridge-to-bridge strategies from paracorporeal to implantable left ventricular assist devices on the pre-heart transplant outcome: A single-center analysis of 134 cases
Impact of bridge-to-bridge strategies from paracorporeal to implantable left ventricular assist devices on the pre-heart transplant outcome: A single-center analysis of 134 cases
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DOI：
10.1016/j.jjcc.2020.11.003
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发表时间：
2021-03-01
影响因子：
2.5
通讯作者：
Fukushima, Norihide
中科院分区：
文献类型：
--
作者：
Nakajima, Seiko;Seguchi, Osamu;Fukushima, Norihide
背景资料：在日本，患有心力衰竭的患者，如果有旁路左心室辅助装置（pLVAD），并且无法脱离VAD，则可以通过桥接至移植（BTT）的桥接至桥接（BTB）策略转换为植入式连续流LVAD（iLVAD）。本研究旨在评估BTB策略的真实临床状态。方法：在134例接受iLVAD植入治疗BTT的患者中，34例患者接受了pLVAD转换为iLVAD（BTB组），100例患者接受了iLVAD植入（原发性iLVAD组）。比较两组患者的临床特点及预后。结果：两组的总生存率无显著差异（p = 0.26;对数秩检验）。然而，BTB组的1年生存率和1年无死亡、卒中、全身感染和出血率复合事件的比率低于初级iLVAD组（生存率，88.2% vs. 99.0%，p = 0.0040;复合无事件生存率，26.1% vs. 49.8%，p = 0.030;对数秩检验）。多变量分析表明，BTB策略[风险比（HR）1.70，95%置信区间（CI）1.03 - 2.72; p = 0.036]和iLVAD植入时的血清总胆红素水平[HR 1.31，95% CI 1.00 - 1.65; p = 0.043]是1年复合事件的独立预测因子。BTB策略有助于急性危重病患者的长期生存。然而，接受BTB策略的患者转换后的早期死亡率较高。(c)2020年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: In Japan, patients with heart failure who have a paracorporeal left ventricular assist device (pLVAD) and cannot be weaned from the VAD may undergo conversion to implantable continuous-flow LVAD (iLVAD) via a bridge-to-bridge (BTB) strategy for bridge-to-transplantation (BTT). This study aimed to evaluate the real-world clinical status of BTB strategies.Methods: Among 134 patients who underwent iLVAD implantation for BTT, 34 patients underwent conversion from pLVAD to iLVAD (BTB group) and 100 patients underwent iLVAD implantation primarily (primary iLVAD group). The clinical characteristics and outcomes were compared between the two groups. Results: No significant difference was found in the overall survival between the two groups ( p = 0.26; log-rank test). However, the 1-year survival rate and the 1-year freedom from the composite events of death, stroke, systemic infection, and bleeding rate were lower in the BTB group than in the primary iLVAD group (survival rate, 88.2% vs. 99.0%, p = 0.0040; composite event-free survival rate, 26.1% vs. 49.8%, p = 0.030; log-rank test). Multivariate analysis indicated that the BTB strategy [hazard ratio (HR) 1.70, 95% confidence intervals (CI) 1.03-2.72; p = 0.036] and serum total bilirubin levels at iLVAD implantation [HR 1.31, 95% CI 1.00-1.65; p = 0.043] were independent predictors of 1-year composite events.Conclusions: The BTB strategy is useful in providing long-term survival in patients with acute critical diseases. However, the early mortality rate after conversion is higher in patients who underwent the BTB strategy.(c) 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.