Farrar David J, Holman William R, McBride Lawrence R, Kormos Robert L, Icenogle Timothy B, Hendry Paul J, Moore Charles H, Loisance Daniel Y, El-Banayosy Aly, Frazier Howard
California Pacific Medical Center, San Francisco, California, USA.
J Heart Lung Transplant. 2002 May;21(5):516-21. doi: 10.1016/s1053-2498(01)00408-9.
In certain forms of severe heart failure there is sufficient improvement in cardiac function during ventricular assist device (VAD) support to allow removal of the device. However, it is critical to know whether there is sustained recovery of the heart and long-term patient survival if VAD bridging to recovery is to be considered over the option of transplantation.
To determine long-term outcome of survivors of VAD bridge-to-recovery procedures, we retrospectively evaluated 22 patients with non-ischemic heart failure successfully weaned from the Thoratec left ventricular assist device (LVAD) or biventricular assist device (BVAD) after recovery of ventricular function at 14 medical centers. All patients were in imminent risk of dying and were selected for VAD support using standard bridge-to-transplant requirements. There were 12 females and 10 males with an average age of 32 (range, 12-49). The etiologies were 12 with myocarditis, 7 with cardiomyopathies (4 post-partum [PPCM], 1 viral [VCM], and 2 idiopathic [IDCM]), and 3 with a combination of myocarditis and cardiomyopathy. BVADs were used in 13 patients and isolated LVADs in 9 patients, for an average duration of 57 days (range, 11-190 days), before return of ventricular function and successful weaning from the device. Post-VAD survival was compared with 43 VAD bridge-to-transplant patients with the same etiologies who underwent cardiac transplantation instead of device weaning.
Nineteen of the 22 patients are currently alive. Three patients required heart transplantation, 1 within 1 day, 2 at 12 and 13 months post-weaning, and 2 died at 2.5 and 6 months. The remaining 17 patients are alive with their native hearts after an average of 3.2 years (range, 1.2-10 years). The actuarial survival of native hearts (transplant-free survival) post-VAD support is 86% at 1 year and 77% at 5 years, which was not significantly different (p = 0.94) from that of post-VAD transplanted patients, also at 86% and 77%, respectively.
Long-term survival for bridge-to-recovery with VADs for acute cardiomyopathies and myocarditis is equivalent to that for cardiac transplantation. Recovery of the native heart, which can take weeks to months of VAD support, is the most desirable clinical outcome and should be actively sought, with transplantation used only after recovery of ventricular function has been ruled out.
在某些严重心力衰竭的形式中，心室辅助装置（VAD）支持期间心脏功能有足够改善，从而可以移除该装置。然而，如果要考虑VAD过渡到恢复而非移植选项，了解心脏是否能持续恢复以及患者长期生存情况至关重要。
为了确定VAD过渡到恢复程序幸存者的长期结局，我们回顾性评估了14个医学中心的22例非缺血性心力衰竭患者，这些患者在心室功能恢复后成功从Thoratec左心室辅助装置（LVAD）或双心室辅助装置（BVAD）撤机。所有患者都面临即将死亡的风险，并根据标准的过渡到移植要求选择接受VAD支持。有12名女性和10名男性，平均年龄为32岁（范围12 - 49岁）。病因包括12例心肌炎、7例心肌病（4例产后心肌病[PPCM]、1例病毒性心肌病[VCM]和2例特发性心肌病[IDCM]）以及3例心肌炎合并心肌病。13例患者使用BVAD，9例患者使用单独的LVAD，在心室功能恢复并成功撤机前平均使用时间为57天（范围11 - 190天）。将VAD支持后的生存情况与43例病因相同但接受心脏移植而非装置撤机的VAD过渡到移植患者进行比较。
22例患者中有19例目前存活。3例患者需要心脏移植，1例在撤机后1天内，2例分别在撤机后12个月和13个月，2例分别在2.5个月和6个月死亡。其余17例患者在平均3.2年（范围1.2 - 10年）后以自身心脏存活。VAD支持后自身心脏的精算生存率（无移植生存）1年时为86%，5年时为77%，与VAD支持后接受移植患者的精算生存率（分别为86%和77%）无显著差异（p = 0.94）。
急性心肌病和心肌炎患者通过VAD过渡到恢复的长期生存率与心脏移植相当。自身心脏的恢复，这可能需要数周数月的VAD支持，是最理想的临床结局，应积极寻求，仅在排除心室功能恢复后才使用移植。
