高龄非心脏移植候选人的高级心力衰竭的目的地治疗策略:来自LEVO-D和REGALAD注册表的倾向匹配分析
David Dobarro1, Sergio Raposeiras-Roubin1, Luis Almenar-Bonet2
1Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, IIS Galicia Sur, 36312 Vigo, Spain.
Life (Basel, Switzerland)
|January 8, 2025
概括
对于不能接受心脏移植的高级心力衰竭患者,左心室辅助器件 (LVAD) 提供了比间歇性左心室辅助器件更好的长期存活率. 对于那些不适合使用LVAD的人来说,levosimendan可能是一个合理的替代品.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 药理学 药理学是指药理学的学科.
背景情况:
- 心脏移植 (HT) 是高级心力衰竭 (ADHF) 的黄金标准,但许多患者不符合条件.
- 左心室辅助器件 (LVAD) 是非HT候选人的目的地治疗的选择.
- 需要采取替代策略,因为大多数ADHF患者既不接受HT,也不接受LVAD.
研究的目的:
- 为了比较重复间歇性levosimendan与LVAD作为终端阶段心力衰竭患者的目标治疗的疗效,这些患者不符合HT的条件.
- 在现实世界患者队列中评估这两种治疗策略的长期结果.
主要方法:
- 来自西班牙的两个多中心队列的比较:LEVO-D (间歇性levosimendan) 和REGALAD (LVAD目的地疗法).
- 分析包括715名患者 (403名来自LEVO-D,312名来自REGALAD).
- 对非调整和匹配的队列进行了生存分析.
主要成果:
- 在未调整后的中位数生存时间对于levosimendan组来说是较短的.
- LVAD治疗显示出生存优势,主要是在治疗的第一年后.
- 这种生存益处在匹配的队列分析中得到证实.
结论:
- 在不符合HT的老年ADHF患者中,LVAD治疗比间歇性levosimendan提供了明显更好的长期结果.
- 对于精心挑选的候选人,应该考虑使用LVAD.
- 间歇性levosimendan可能是不适合LVAD或高并发症的患者的可行的替代方案,考虑到类似的1年结果.
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