在VAD治疗中,护理差距不断扩大
Jennifer Conway1, Shahnawaz Amdani2, David L S Morales3
1Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
概括
随着HeartWare心室辅助装置 (HVAD) 的移除,对年轻患者造成了差距. 心脏Mate 3 (HM3) 提供了良好的生存率,但儿科患者可能仍然面临身体内支持的访问限制.
科学领域:
- 心脏病学 心脏病学
- 儿童心脏病学 儿童心脏病学
- 医疗器械 医疗器械
背景情况:
- 停止使用HeartWare心室辅助装置 (HVAD) 造成了儿童和年轻成人患者的护理缺口.
- 目前尚不清楚HVAD存活率如何因年龄而异,以及HeartMate 3 (HM3) 是否能够充分解决这一差距.
研究的目的:
- 为了比较年轻成人 (YA) 和植入持久心室辅助器件 (VAD) 的儿科患者的生存结果.
- 评估HeartMate 3 (HM3) 设备在弥合HVAD留下的护理差距方面的性能.
主要方法:
- 在2012年9月至2021年12月期间使用了STS Intermacs和Pedimacs注册表用于VAD植入物.
- 定义年轻成年人为40岁以下,并排除具有孤立RVAD或目的地治疗植入物的患者.
- 使用卡普兰-梅尔曲线和竞争结果进行生存分析,报告1年生存率.
主要成果:
- 年轻成年人 (YA) 的HVAD存活率比老年人 (>40岁) (88.8%vs79.4%) 更好.
- 亚年生存率优于儿科患者 (88.9% vs 83.7%),但当考虑竞争事件时,死亡率相似.
- 与HVAD相比,HeartMate 3 (HM3) 显示YA的生存率有所改善 (94.4%与88.8%相比),这一差异在所有儿科患者中没有观察到.
结论:
- 该HeartMate 3 (HM3) 设备可以部分填补HVAD移除后年轻患者的护理缺口.
- 一部分儿科患者在获得体内支持方面仍可能面临限制,这会影响出院潜力.
- 未来的设备可用性决定必须考虑多样化的患者群体,以防止获得不平等.
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