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晚期心力衰竭患者治疗心室辅助器件的患者的结局
Lyle W Baker1, Tambi Jarmi2, Michael A Mao1
1Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL.
Kidney medicine
|July 4, 2025
概括
心室辅助器件 (VAD) 植入最初改善了功能,特别是在慢性病 (CKD) 患者中,但益处正在减弱. 急性损伤 (AKI) 和置换疗法 (KRT) 是VAD后常见的,需要密切监测.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學.
- 医疗器械 医疗器械
背景情况:
- 晚期心力衰竭通常需要心室辅助器件 (VAD).
- VADs对功能的影响,包括急性损伤 (AKI) 和替代疗法 (KRT) 的需求,仍然不完全理解.
研究的目的:
- 为了评估VAD植入后功能变化.
- 评估接受VADs的患者中AKI的发生率和KRT的需要.
- 探索先前存在的慢性病 (CKD) 对VAD后结局的影响.
主要方法:
- 对接受持久VAD安置的成年患者进行回顾性队列研究 (2009-2019).
- 患者分为CKD (eGFR <60毫升/分钟/1.73m2) 和非CKD (eGFR ≥60毫升/分钟/1.73m2) 的两组.
- 在VAD后3个月和12个月对纵向功能 (eGFR,肌素),AKI发病率和KRT需求的分析.
主要成果:
- 在CKD患者中,VAD安置最初改善了功能 (3个月的EGFR+17),但这种益处减少了12个月 (EGFR+7).
- 非CKD患者在功能方面表现出较小,不持续的改善.
- 需要KRT的AKI发生在14%的患者中,有显著的住院死亡率 (45%);21%的患者经历了出院后的AKI.
结论:
- VAD植入提供了功能最初的改善,特别是在CKD患者中,尽管这种效果不会持续长期.
- AKI和KRT要求的高发病率强调了对患有VAD的患者进行警性功能监测的迫切需要.
- 心脏移植后的VAD与1年后功能恶化有关.
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