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進行性心不全における循環器の機械的サポート:患者の選択が結果に与える影響
M C Deng1, M Loebe, A El-Banayosy
1Cardiothoracic Surgery and Transplant Center, Westfalian Wilhelms University Münster, Münster, Germany. md785@columbia.edu
Circulation
|February 24, 2001
まとめ
左心室補助システム (LVAS) の患者の選択は,進行性心不全の生存にとって極めて重要です. 呼吸器不全や年齢などのプリインプラントリスク要因を特定することは,結果に大きく影響します.
科学分野:
- 心臓病学 心臓病学
- 医療機器 医療機器について
- 心不全管理について
背景:
- ウェアラブル左心室補助システム (LVAS) の使用は,1993年以来,進行性心不全において増加しています.
- ヨーロッパでのLVASの利用可能性は,臨床実務におけるより広範な採用を促した.
研究 の 目的:
- LVASインプランテーション後の生存に影響を与える患者の選択要因を特定する.
- LVAS受給者の未選択コホートにおけるアウトカムを分析する.
主な方法:
- 464人のLVAS受給者によるNovacor欧州登録 (1993年~1999年) のデータを活用した.
- 完全なデータを持つ366人の患者のサブセットで多変量分析を行った.
- 生存のための独立した危険因子として,インプラント前の条件を特定した.
主要な成果:
- 死亡率の主な危険因子には,呼吸機能不全 (OR 11.2),右心不全 (OR 3.2),65歳以上の年齢 (OR 3.01) が含まれる.
- 急性心筋切開後手術 (OR1.8) と急性心臓発作 (OR1.7) も重要なリスク因子でした.
- 危険因子のない患者の1年生存率は60%で,少なくとも1つの危険因子を持つ患者の24%に低下しました.
結論:
- 死にかけている前に慎重に患者を選択することは,LVASの結果を改善するために不可欠です.
- 患者の管理戦略の改善は,進行した心不全の生存率をさらに改善する可能性があります.
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