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三年后的左心室辅助器件结果和心脏移植后的策略 分配分数变化
Jacob Agronin1, Meredith Brown2, Hannah Calvelli2
1Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania.
The American journal of cardiology
|July 7, 2024
概括
2018年UNOS心脏分配分数的变化减少了左心室辅助器件 (LVAD) 的使用. 暂时的机械支持增加了,但心脏移植接受者的3年生存率仍然相当.
科学领域:
- 心脏病学 心脏病学
- 移植医学 移植医学
- 医疗政策 医疗政策
背景情况:
- 美国器官共享网络 (UNOS) 在2018年10月更新了心脏分配标准,以应对不断变化的候选死亡风险.
- 左心室辅助装置 (LVAD) 的使用已增加,作为通往心脏移植的桥梁.
- 了解政策变化对机械循环支器械策略的影响至关重要.
研究的目的:
- 评估2018年UNOS心脏分配得分修订对LVAD植入率的影响.
- 评估政策变化后使用临时机械循环支持 (MCS) 设备的变化.
- 为了比较在政策更新之前和之后列出的患者之间的移植后结果.
主要方法:
- 在2016年1月至2020年3月期间,利用UNOS注册表识别成人首次心脏接受者,在注册或移植时使用LVAD支持.
- 根据2018年10月18日政策变更日期将患者分为"之前"和"之后"组.
- 分析了人口统计,临床参数和生存数据 (收集到2023年3月),使用卡普兰-梅尔曲线和日志等级测试.
主要成果:
- 确定了4,387名受益者:在得分变化之前有3,606人,在得分变化后有781人.
- "之后"组显示LVAD植入量显著下降 (20.4%与34.9%相比),但使用临时MCS (例如ECMO,内类药物) 增加.
- "之后"组的移植中心的旅行距离更长,等候名单时间更短,可比的3年生存率.
结论:
- 2018年UNOS分配分数的修订大大改变了机械循环支持装置的策略.
- 观察到LVAD植入量的减少,伴随着临时MCS设备使用量的增加.
- 尽管MCS支持的战略转变,但移植后3年生存率在两个时代之间保持一致.
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