Jurmann Michael J, Weng Yuguo, Drews Thorsten, Pasic Miralem, Hennig Ewald, Hetzer Roland
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Eur J Cardiothorac Surg. 2004 Apr;25(4):610-8. doi: 10.1016/j.ejcts.2004.01.017.
This study details our initial results of long-term left ventricular assist device (LVAD) support in patients suffering from catecholamine-dependent end-stage heart failure or cardiogenic shock with age above 65 years or age above 60 and contraindications to cardiac transplantation.
Between September 2000 and July 2002, 27 patients received implantation of left ventricular assist devices (Micromed DeBakey (n=15), Berlin Heart Excor (n=6), Arrow Lion Heart (n=4) and Novacor N100 (n=2)). The mean age of this group was 66.2+/-4.1 (60-77) years. The patients presented with the following features by the time of LVAD implantation: failure of weaning from inotropic support (78%), either profound cardiogenic shock (37%) or instable hemodynamic status (22%), high-dose inotropic (52%) or intraaortic balloon pump support (11%), dialysis (15%), artificial ventilation (15%), and at least one previous cardiac procedure (44%).
The cumulative survival rate for the whole group was 63% at 30 days, 30% at 180 days, and 22% at 2 years. The presence of preoperative cardiogenic shock was associated with a higher perioperative mortality rate. Late complications (n=7) included replacement of two thrombosed DeBakey LVADs and five late deaths secondary to thrombembolism/intracranial hemorrhage (DeBakey LVAD, n=3) or septicemia (n=2). As of May 15, 2003, six patients remain on LVAD support for an average of 653 (339-953) days, three patients now for more than 2 years. Ten patients were discharged home to spend 73% of their life span on out-of-hospital long-term LVAD support.
This study reports the first single-center experience of permanent LVAD support in patients of advanced age. For this initial experience, many patients with critical circulatory status and previous cardiac operations were included and a high postoperative mortality rate was encountered among them. Older age and associated multimorbidity are the key determinants rendering the conditions of LVAD therapy for this patient cohort to be different from the bridge-to-transplant experience. The LVADs employed in this study showed different capabilities with regard to long-term support. Our experience shows that permanent mechanical circulatory support does have the potential to evolve as a treatment option in selected elderly patients with end-stage heart failure.
本研究详细介绍了我们对年龄在65岁以上或60岁以上且有心脏移植禁忌症的儿茶酚胺依赖性终末期心力衰竭或心源性休克患者进行长期左心室辅助装置（LVAD）支持的初步结果。
2000年9月至2002年7月期间，27例患者接受了左心室辅助装置植入（Micromed DeBakey（n = 15）、柏林心脏Excor（n = 6）、箭狮之心（n = 4）和Novacor N100（n = 2））。该组患者的平均年龄为66.2±4.1（60 - 77）岁。这些患者在植入LVAD时具有以下特征：无法停用正性肌力支持（78%）、严重心源性休克（37%）或血流动力学状态不稳定（22%）、高剂量正性肌力药物（52%）或主动脉内球囊泵支持（11%）、透析（15%）、人工通气（15%）以及至少有一次既往心脏手术（44%）。
全组患者30天累计生存率为63%，180天为30%，2年为22%。术前存在心源性休克与围手术期死亡率较高相关。晚期并发症（n = 7）包括更换两个发生血栓形成的DeBakey LVAD以及5例因血栓栓塞/颅内出血（DeBakey LVAD，n = 3）或败血症（n = 2）导致的晚期死亡。截至2003年5月15日，6例患者仍在接受LVAD支持，平均时间为653（339 - 953）天，3例患者目前已超过2年。10例患者出院回家，在院外长期接受LVAD支持的时间占其寿命的73%。
本研究报告了首例针对高龄患者进行永久性LVAD支持的单中心经验。对于这一初步经验，纳入了许多循环状态危急且既往有心脏手术史的患者，其中术后死亡率较高。高龄及相关的多种合并症是使该患者群体的LVAD治疗条件不同于桥接移植经验的关键决定因素。本研究中使用的LVAD在长期支持方面表现出不同的能力。我们 的经验表明，永久性机械循环支持确实有可能发展成为选定的老年终末期心力衰竭患者的一种治疗选择。
