El-Banayosy A, Arusoglu L, Kizner L, Tenderich G, Boethig D, Minami K, Körfer R
Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany.
J Heart Lung Transplant. 2000 Oct;19(10):964-8. doi: 10.1016/s1053-2498(00)00174-1.
Careful patient selection markedly influences the outcome of patients who undergo mechanical circulatory support. Therefore, we tried to evaluate predictors of survival after implantation of the Thoratec ventricular assist device (VAD).
Between October 1992 and January 2000, 104 patients (86 men, 18 women, aged 11 to 69 years) received the Thoratec VAD as a bridge to transplant. A total of 51 patients required left ventricular support (LVAD), 50 patients required biventricular support (BVAD), and 3 patients required total artificial heart implantation. We performed univariate analysis of 25 parameters with regard to their effect on survival and then applied a multivariate analysis to evaluate those factors that turned out to be marginally significant. We performed all analysis for the total collective as well as for the LVAD and BVAD sub-group.
The BVAD patients tended to have worse outcomes than did LVAD patients. We found no significant predictors of survival in either sub-group. In the total collective, however, we found the following pre-implant conditions were independent risk factors for survival after VAD implantation: patient age > 60 years (odds ratio [OR] 3.87, confidence interval [CI] 1.39 to 10.76), pre-implant ventilation (OR, 6.76; CI 2.42 to 18.84), and increased pre-implant total bilirubin (OR, 1.42; CL, 1.19 to 1.69).
Transplant candidates on inotropic support should be considered for bridging to transplant as soon as bilirubin values start to increase or before respiratory function deteriorates and ventilation becomes necessary. In elderly patients, careful patient selection, particularly considering potential risk factors, might favorably affect their outcomes.
仔细的患者选择对接受机械循环支持的患者的预后有显著影响。因此，我们试图评估植入Thoratec心室辅助装置（VAD）后生存的预测因素。
在1992年10月至2000年1月期间，104例患者（86例男性，18例女性，年龄11至69岁）接受了Thoratec VAD作为移植桥梁。共有51例患者需要左心室支持（LVAD），50例患者需要双心室支持（BVAD），3例患者需要植入全人工心脏。我们对25个参数对生存的影响进行了单因素分析，然后进行多因素分析以评估那些结果显示为边缘显著的因素。我们对整个群体以及LVAD和BVAD亚组进行了所有分析。
BVAD患者的预后往往比LVAD患者差。我们在任何一个亚组中都未发现生存的显著预测因素。然而，在整个群体中，我们发现以下植入前情况是VAD植入后生存的独立危险因素：患者年龄>60岁（优势比[OR]3.87，置信区间[CI]1.39至10.76）、植入前通气（OR，6.76；CI 2.42至18.84）以及植入前总胆红素升高（OR，1.42；CL，1.19至1.69）。
对于接受正性肌力药物支持的移植候选者，一旦胆红素值开始升高或在呼吸功能恶化和通气成为必要之前，就应考虑作为移植桥梁。对于老年患者，仔细的患者选择，特别是考虑潜在危险因素，可能会对其预后产生有利影响。
