Four-year outcomes with third-generation centrifugal left ventricular assist devices in an era of restricted transplantation.
Four-year outcomes with third-generation centrifugal left ventricular assist devices in an era of restricted transplantation.
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DOI：
10.1093/ejcts/ezu258
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发表时间：
2014-09
期刊：
影响因子：
--
通讯作者：
MacGowan GA
中科院分区：
文献类型：
--
作者：
Özalp F;Bhagra S;Bhagra C;Butt T;Ramesh B;Robinson-Smith N;Wrightson N;Parry G;Griselli M;Hasan A;Schueler S;MacGowan GA
第三代心室辅助装置（vad）与改善的结果相关，尽管在最近的临床试验中，6个月的桥接移植（BTT）率约为30%，因此移植可以用作严重并发症的“救助”。在英国，在过去的十年里，心脏移植率有了显著的下降，因此vad移植的频率要低得多。本研究的目的是确定低BTT率情况下的结局及其预测因素，以及当患者接受长期支持时，VAD血栓的发生率和结局。我们分析了2009年至2013年间连续102例患者的结局（平均年龄47±13岁；VentrAssist n = 6, HeartWare n = 96）。中位支持时间为462±426天。1年和2年生存率分别为75%和66%。年龄较大和急性期INTERMACS组与前90天生存率降低显著相关（P分别为0.030和0.010）。术前右心室（RV）功能差对1年后的生存率有负面影响（P = 0.009），但在此之前没有影响。VAD血栓形成（n = 24 HeartWare和n = 1 VentrAssist）的中位发病时间为404±281天，HeartWare组为0.18例/患者年，VentrAssist组为0.07例/患者年。VAD血栓形成对患者生存无明显影响。102例患者中只有14例在中位时间（334±347天）内移植，只有3例在前6个月内移植。移植率较低的第三代左室辅助装置植入与目的治疗的生存率相似，但易出现VAD血栓形成和右心衰等长期并发症。
Third-generation ventricular assist devices (VADs) are associated with improved outcomes, though in recent clinical trials bridge-to-transplant (BTT) rates are ∼30% at 6 months, so that transplantation can be used as a ‘bail out’ for serious complications. In the UK, there was a significant reduction in heart transplantation rates over the last decade, so that transplantation from VADs is much less frequent. The objective of this study was to determine outcomes and their predictors in this situation of low BTT rates, and as patients were exposed to long-term support, the incidence and outcomes of VAD thrombosis. We analysed outcomes for 102 consecutive patients between 2009 and 2013 (mean age 47 ± 13; VentrAssist n = 6 and HeartWare n = 96). The median duration of support was 462 ± 426 days. Survival rates on the device were 75 and 66% at 1 and 2 years, respectively. Older age and more acute INTERMACS groups were significantly related to reduced survival within the first 90 days (P = 0.030 and 0.010, respectively). Poor preoperative right ventricular (RV) function had a negative effect on survival after 1 year (P = 0.009), though not earlier. VAD thrombosis (n = 24 HeartWare and n = 1 VentrAssist) occurred at 0.18 events per patient-year for HeartWare and 0.07 for VentrAssist devices at a median time of onset at 404 ± 281 days. There was no significant effect of VAD thrombosis on survival. Only 14 of 102 patients were transplanted at a median of 334 ± 347 days, and only 3 were transplanted within the first 6 months. Third-generation left ventricular assist device implants with a low rate of transplantation have similar survival to destination therapy, and are susceptible to long-term complications of VAD thrombosis and right heart failure.
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DOI：
10.1111/j.1751-7133.2012.00302.x
发表时间：
2013-01-01
期刊：
Congestive heart failure (Greenwich, Conn.)
影响因子：
--
作者：
McDiarmid, Adam;Gordon, Brian;MacGowan, Guy A
通讯作者：
MacGowan, Guy A
影响因子：
8.9
作者：
Baumwol, Jay;Macdonald, Peter S.;Hayward, Christopher S.
通讯作者：
Hayward, Christopher S.
影响因子：
8.9
作者：
Najjar, Samer S.;Slaughter, Mark S.;Boyce, Steven W.
通讯作者：
Boyce, Steven W.
影响因子：
158.5
作者：
Starling, Randall C.;Moazami, Nader;Smedira, Nicholas G.
通讯作者：
Smedira, Nicholas G.
影响因子：
8.9
作者：
Stevenson, Lynne Warner;Pagani, Francis D.;Kirklin, James K.
通讯作者：
Kirklin, James K.