在目的地治疗中心植入左心室辅助装置后,管理右心室衰竭
Timothy J George1, Jenelle Sheasby1, Greg Milligan1
1Baylor Scott and White, The Heart Hospital, Plano, Texas.
The American journal of cardiology
|June 22, 2023
概括
需要右心室辅助装置 (RVAD) 的左心室辅助装置 (LVAD) 植入物增加了手术死亡率. 然而,RVAD植入后的幸存者显示的生存率与没有RVAD的幸存者相似,这表明对精心挑选的患者有好处.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 医疗器械 医疗器械
背景情况:
- 左心室辅助装置 (LVAD) 植入改善了末期心力衰竭的生存率.
- 右心室辅助装置 (RVAD) 的安置显著增加了短期发病率和死亡率.
- 对于心力衰竭患者来说,无法接受移植的选择有限,这影响了非移植中心的决策.
研究的目的:
- 评估LVAD植入物的结果,特别是根据术后RVAD的需要进行分层.
- 评估RVAD安置对在非移植中心进行LVAD植入的患者的生存率的影响.
主要方法:
- 在2017年至2022年期间进行的128个LVAD植入物的回顾性审查.
- 基于对外科手术期间RVAD安置的要求进行分层 (24名患者,18.75%).
- 使用考克斯比例危险回归模型进行生存分析.
主要成果:
- 植入RVAD与显著增加的手术死亡率 (33.33%对1.92%) 和降低1年和2年生存率 (60.60%和36.36%对91.29%和84.05%) 相关.
- 在最初住院后幸存下来的患者中,1年和2年死亡率在各组之间相似 (91.67%vs93.00%和55.00%vs86.16%).
- 多变量分析表明,RVAD需要增加1年和2年死亡率的危险 (HR 5.60和5.17).
结论:
- 尽管手术风险增加,但需要RVAD支持的LVAD患者在住院后幸存下来,在非移植中心表现出可接受的短期生存率.
- 精心挑选的双心脏衰竭患者可能会从LVAD植入中受益,即使预计会支持RVAD.
- 这些发现支持LVAD作为选择心力衰竭患者而没有移植资格的可行选择.
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