Feller Erika D, Sorensen Erik N, Haddad Michel, Pierson Richard N, Johnson Frances L, Brown James M, Griffith Bartley P
Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
Ann Thorac Surg. 2007 Mar;83(3):1082-8. doi: 10.1016/j.athoracsur.2006.10.034.
Despite concerns about the adequacy of support provided by continuous-flow left ventricular assist devices (LVADs), direct comparisons of patient characteristics and outcomes between first-generation pulsatile and second-generation nonpulsatile LVADs are absent. We hypothesized that a nonpulsatile Jarvik 2000 LVAD (Jarvik Heart, Inc, New York, NY) would result in comparable outcomes to those of similarly ill patients implanted with a pulsatile LVAD (Novacor, WorldHeart Inc, Oakland, CA; and HeartMate XVE, Thoratec, Pleasanton, CA).
We retrospectively compared common pre-LVAD clinical characteristics and indicators of heart failure severity between 13 pulsatile and 14 nonpulsatile LVAD recipients. The outcomes analyzed were either heart transplantation, if the LVAD was intended as a bridge to transplantation, or hospital discharge if the intention was destination therapy.
There was no significant difference between groups in pre-LVAD disease severity indicators. Nonpulsatile LVAD recipients had a significantly smaller body surface area (1.9 +/- 0.2 m2 versus 2.1 +/- 0.2 m2, p = 0.04) and cardiopulmonary bypass time was also significantly shorter (61 +/- 34 minutes versus 110 +/- 49 minutes, p = 0.01). Aside from duration of initial intensive care unit stay (nonpulsatile, 10 +/- 16 days; pulsatile, 14 +/- 11 days; p = 0.02), there was no difference in post-LVAD outcomes: 10 of 14 nonpulsatile and 8 of 13 pulsatile LVAD patients achieved the combined end point (p = 0.69).
Similarly ill congestive heart failure patients benefited equally well from either a nonpulsatile or a pulsatile LVAD. This may support an expanded role for nonpulsatile LVADs in the treatment of severe heart failure.
尽管人们对连续血流左心室辅助装置（LVAD）提供的支持是否充足存在担忧，但第一代搏动性和第二代非搏动性LVAD之间患者特征和结局的直接比较尚不存在。我们假设，非搏动性Jarvik 2000 LVAD（Jarvik Heart公司，纽约州纽约市）与植入搏动性LVAD（Novacor，WorldHeart公司，加利福尼亚州奥克兰市；以及HeartMate XVE，Thoratec公司，加利福尼亚州普莱森顿市）的病情相似患者的结局相当。
我们回顾性比较了13例搏动性LVAD接受者和14例非搏动性LVAD接受者LVAD植入前的常见临床特征和心力衰竭严重程度指标。分析的结局要么是心脏移植（如果LVAD旨在作为移植桥梁），要么是出院（如果目的是目标治疗）。
LVAD植入前疾病严重程度指标在两组之间无显著差异。非搏动性LVAD接受者的体表面积显著较小（1.9±0.2 m²对2.1±0.2 m²，p = 0.04），体外循环时间也显著更短（61±34分钟对110±49分钟，p = 0.01）。除了初始重症监护病房住院时间（非搏动性，10±16天；搏动性，14±11天；p = 0.02）外，LVAD植入后的结局没有差异：14例非搏动性LVAD患者中的10例和13例搏动性LVAD患者中的8例达到了联合终点（p = 0.69）。
病情相似的充血性心力衰竭患者从非搏动性或搏动性LVAD中获益相当。这可能支持非搏动性LVAD在严重心力衰竭治疗中发挥更大作用。
