REMATCH後期における目的治療として左心房アシスタント装置の移植の結果:患者の選択への影響
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Katherine Lietz1, James W Long, Abdallah G Kfoury
1Cardiovascular Division, University of Minnesota, Minneapolis, USA. KL2384@columbia.edu
Circulation
|July 20, 2007
まとめ
左心室補助器官 (LVAD) 宛先療法 (DT) は,末期心不全患者の生存率の改善を示しています. 患者の慎重な選択とタイミングは,LVAD治療の最適な結果を得るために不可欠です.
科学分野:
- 心臓病学 心臓病学
- 機械的な循環器のサポート
- 心不全管理について
背景:
- 閉塞性心不全の治療のための機械的支援のランダム化評価 (REMATCH) 試験は,左心室補助器具 (LVADs) を最終段階の心不全の医療治療に優れている目的地療法 (DT) として確立しました.
- この研究は,米国におけるREMATCH後の時代におけるDTの結果を評価しています.
研究 の 目的:
- リマッチ後の時代にLVADを使用した目的地療法 (DT) のアウトカムを記述する.
- LVADのインプラント化後の入院死亡率に関する術前リスクスコアを確立するために.
主な方法:
- 2001年11月から2005年12月までの間にHeartMate XVE LVADインプラントを受けた280人の患者の分析.
- 222人の患者のデータを用いて,手術前リスクスコアの開発.
- 死亡または2006年12月までの追跡調査.
主要な成果:
- LVADの移植後の1年生存率は56%で,入院死亡率は27%でした.
- 病院での死亡率の主要な決定要因には,栄養不良,血液学的異常,末端器官または右心室機能不全,およびイノトロピックサポートの欠如が含まれています.
- リスクの階層化により,低 (81%),中 (62%),高 (28%),非常に高 (11%) の生存率と異なるリスクグループが特定されました.
結論:
- 最適な候補者の選択とLVADの植え付けの正確なタイミングは,成功的なDTの結果にとって非常に重要です.
- 主要な合併症の前にDTに推薦された進行性心不全の患者は,LVAD治療で最高の1年生存率を経験します.
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