An Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of hospitalization, functional status, and mortality after mechanical circulatory support in adults with congenital heart disease
An Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) analysis of hospitalization, functional status, and mortality after mechanical circulatory support in adults with congenital heart disease
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DOI：
10.1016/j.healun.2017.11.010
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发表时间：
2018-05-01
影响因子：
8.9
通讯作者：
Kirklin, James K.
中科院分区：
文献类型：
--
作者：
Cedars, Ari;Vanderpluym, Christina;Kirklin, James K.
背景：成人先天性心脏病（ACHD）在世界范围内的患病率正在上升，晚期心力衰竭（HF）是导致死亡的主要原因。关于慢性心脏病患者的持久机械循环支持（MCS）的数据有限。方法：从机构间机械辅助循环支持登记（INTERMACS）数据库中识别出ACHD患者，并使用INTERMACS第七次年度报告中的危险因素与非ACHD患者进行倾向匹配。我们比较了这些组的mcs后死亡率的主要结局。我们还调查了不良事件发生率、功能状态和健康相关的生活质量。结果：ACHD（128例）和非ACHD（512例）患者根据基线特征进行了适当匹配。ACHD患者在MCS植入物的停留时间更长（24天vs 19天，p = 0.006），但MCS后不良事件和住院率相似。两组患者在mcs后的功能状态和健康相关生活质量方面均有相似的改善。ACHD患者仅在植入后的前5个月内，mcs后死亡率明显较高（p = 0.003），接受移植的可能性较低（p = 0.003）。早期死亡的危险因素是双心室或全人工心脏装置植入和年龄在50岁以下。结论：与非ACHD患者相比，ACHD患者在MCS后的早期死亡率更高，但不良事件发生率相似，功能能力和生活质量的改善相似。这些数据支持在选定的ACHD患者中扩大MCS的使用。(C) 2017国际心肺移植学会。版权所有。
BACKGROUND: Adult congenital heart disease (ACHD) prevalence is increasing worldwide, with advanced heart failure (HF) as a leading cause of death. Limited data are available on durable mechanical circulatory support (MCS) in ACHD patients.METHODS: ACHD patients from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database were identified and propensity matched with non-ACHD patients using risk factors from the INTERMACS Seventh Annual Report. We compared these groups for the primary outcome of post-MCS mortality. We also investigated adverse event rates, functional status, and health-related quality of life.RESULTS: ACHD (n = 128) and non-ACHD (n = 512) patients were appropriately matched by baseline characteristics. ACHD patients had a longer length of stay at MCS implant (24 vs 19 days, p = 0.006) but similar rates of post-MCS adverse events and hospitalization. There were similar improvements in functional status and health related quality of life post-MCS in both groups. ACHD patients had significantly higher mortality post-MCS exclusively during the first 5 months after implant (p = 0.003) and a lower probability of receiving a transplant (p = 0.003). Risk factors for early mortality were biventricular or total artificial heart device implant and age > 50 years.CONCLUSIONS: ACHD patients experience a higher early mortality after MCS but have similar adverse event rates and similar improvements in functional capacity and quality of life compared with non-ACHD patients. These data support expansion of MCS use in selected ACHD patients. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.