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在循环死亡心脏移植心脏移植后捐赠的耐用左心室辅助装置

Yeahwa Hong¹, Umar Nasim², Nidhi Iyanna³

¹Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

|February 13, 2025

概括

循环死亡 (DCD) 心脏移植后的捐赠,在持久左心室辅助器件 (LVAD) 患者中显示生存率较低. 然而,随着更高的敏度和特定设备的使用,结果会有所改善,这证明DCD移植对LVAD患者来说是安全的.

科学领域:

心脏病学心脏病学
移植医学移植医学
医疗器械医疗器械

背景情况:

循环死亡 (DCD) 心脏移植后的捐赠是一个不断发展的领域.
左心室辅助器件 (LVAD) 对于末期心力衰竭管理至关重要.
在LVAD接受者中评估DCD心脏移植结果对于优化患者护理至关重要.

研究的目的:

评估使用耐用左心室辅助装置 (LVAD) 作为移植桥梁的DCD心脏移植接受者的生存率.
为了比较DCD心脏移植接受者与没有持久的LVAD支持之间的结果.
在这个特定的患者队列中确定影响移植后生存的因素.

主要方法:

对2019年1月至2023年3月的成人隔离DCD心脏移植接受者UNOS注册表的分析.
基于在移植前长期使用LVAD的接受者分层.
移植后1年生存率的评估,包括对移植状态,器械类型和供体类型的子组分析.

主要成果:

在703名接受者中,219人 (31.2%) 使用了持久的LVAD. 与非LVAD接受者 (93.6%,p=0.017) 相比,这些患者的1年生存率 (88.4%) 显着较低.
在LVAD接受者中,状态4患者的生存率有所改善. 与HeartWare HVAD相比,HeartMate II和III设备与更好的结果有关.
与LVAD接收者进行DCD和脑死亡后捐赠 (DBD) 的患者表现出可比的1年生存率 (88.4%与89.0%,p=0.763).

结论:

长期使用LVAD作为通往DCD心脏移植的桥梁,与早期移植后存活率的降低有关.
临床敏度和LVAD设备类型显著影响DDC心脏移植接受者的结果.
DCD心脏移植可以安全地在持久的LVAD候选人中进行,实现与DBD心脏移植相似的存活率.

关键词:

在循环死亡后的捐赠.耐用的左心室辅助装置.机械循环支持机械循环支持 орто托普心脏移植手术移植后的结果.

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