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连续流动的左心室辅助装置对移植后死亡率的影响
Lauren K Truby1, Maryjane A Farr2, A Reshad Garan2
1Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC (L.K.T.).
Circulation
|June 18, 2019
概括
用左心室辅助装置 (LVAD) 进行心脏移植的患者面临更高的早期死亡风险. 对于这些机械支持患者来说,仔细考虑移植资格至关重要.
科学领域:
- 心脏病学
- 移植医学
- 机械循环支持
背景情况:
- 使用左心室辅助器件 (LVAD) 的桥梁移植 (BTT) 是等待心脏移植 (HT) 的末期心力衰竭患者的关键治疗方法.
- 目前的HT清单标准不区分医疗管理和机械桥接患者.
- 本研究研究了LVAD支持的BTT对HT后生存和死亡风险因素的影响.
研究的目的:
- 评估BTT与LVAD对心脏移植后生存率的影响.
- 通过医疗管理和机械桥梁接收者之间的1年死亡原因进行比较.
- 确定在HT时与LVAD和无LVAD患者的1年死亡率相关的风险因素.
主要方法:
- 利用联合器官共享网络数据库从2008年至2015年分析了5486名成年单器官接受者.
- 使用的倾向匹配用于HT的LVAD使用概率.
- 卡普兰 - 梅尔生存分析和后勤回归评估了1年和5年的死亡率和风险因素的概率.
主要成果:
- 与医疗管理的患者相比,机械桥接患者的早期死亡率较高 (在1年内为9. 5%).
- 在BTT患者中观察到1年死亡风险增加,估计球过率在40-60mL·min-1·1. 73m-2和<40mL·min-1·1. 73m-2之间.
- 较高的体重指数 (25-30 kg/ m2 和> 30 kg/ m2) 也与BTT患者的死亡风险增加相关.
结论:
- 虽然LVAD支持的BTT改善了因器官短缺而在等待名单上的存活率,但它显著增加了早期移植后死亡风险.
- 使用机械支的患者需要对LVAD植入后的移植资格进行仔细评估.
- 考虑年龄,功能和BMI等因素的风险分层对于治疗BTT患者至关重要.
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