接受搏动性和非搏动性左心室辅助装置的患者临床结果相似。

Clinical outcomes are similar in pulsatile and nonpulsatile left ventricular assist device recipients.

作者信息

Feller Erika D, Sorensen Erik N, Haddad Michel, Pierson Richard N, Johnson Frances L, Brown James M, Griffith Bartley P

机构信息

Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.

出版信息

Ann Thorac Surg. 2007 Mar;83(3):1082-8. doi: 10.1016/j.athoracsur.2006.10.034.

DOI:10.1016/j.athoracsur.2006.10.034

PMID:17307463

Abstract

BACKGROUND

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).

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

方法

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）。

结果

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）。