终端心力衰竭患者的生存率最大化:在移植之前,桥梁到连续的左心室辅助装置
Joshua G Crane1, Toyokazu Endo, Michele Gallo
1From the Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
概括
持续流动的左心室辅助装置 (CFVAD) 改善了等待移植的末期心力衰竭患者的生存率. 年轻患者特别受益于CFVAD治疗,提高整体生存结果.
科学领域:
- 心脏病学 心脏病学
- 医疗器械 医疗器械
- 移植 移植 移植 移植
背景情况:
- 连续流动左心室辅助器件 (CFVAD) 最初是为末期心力衰竭患者的桥梁到移植 (BTT) 治疗而开发的.
- 评估CFVAD对生存的综合影响,包括移植前和移植后阶段,对于优化患者管理至关重要.
研究的目的:
- 评估CFVAD使用对终期心力衰竭存活率的整体影响,考虑桥梁到移植治疗.
- 为了比较患有CFVAD和没有CFVAD的患者之间的复合生存率,按年龄分层.
主要方法:
- 利用联合国器官共享网络 (UNOS) 数据库 (2005-2024) 用于终期心力衰竭的成年患者.
- 根据CFVAD使用和年龄 (≤50岁与>50岁) 分类患者.
- 通过总结等待名单持续时间,预列名单CFVAD持续时间和移植后生存率来计算复合生存率.
主要成果:
- 总共有55468名患者被分析;18930人接受了CFVAD,36538人没有机械循环支持 (MCS).
- 与增加CFVAD使用相关的因素包括男性性别,黑人种族,血型O,非先天性心肌病和年龄较小.
- 在使用CFVAD的可能性较高的患者中,使用CFVAD的5年复合存活率明显更好 (93%vs81%).
- 使用CFVAD的年轻患者 (<50岁) 与没有MCS和老年患者相比,在5年复合存活率上表现出更高的优势 (95%与92%,85%,84%,p <0.01).
结论:
- 使用CFVAD作为桥梁到移植治疗提供了显著的整体复合存活优势,特别是在年轻的末期心力衰竭患者中.
- 在移植之前,在符合条件的患者中增加CFVAD的植入可能会最大限度地提高长期心力衰竭的存活率.
- 这些发现支持扩大CFVADs的使用,作为心力衰竭管理和移植候选人的关键组成部分.
相关概念视频
Cardiomyopathy V: Interprofessional Care
335
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
335
Heart Failure VI: Adjunct Therapies
252
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
252
Cardiomyopathy II: Dilated Cardiomyopathy
464
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
464
Heart Failure V: Medical Management
215
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
215


