Anderson Mark B, Gratz Eric, Wong Raymond K, Benali Karim, Kung Robert T V
Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA.
J Extra Corpor Technol. 2007 Mar;39(1):43-8.
In this retrospective study, the implant course and outcome of patients with ventricular assist devices (VADs) transferred from outlying "spoke" hospitals and converted nonsurgically to a device designed for ambulation at tertiary care "hub" hospitals are evaluated. Factors affecting the crucial decision to transfer and to convert devices have not previously been characterized. Data from 50 patients at 26 US hub institutions were voluntarily submitted to a VAD data registry at ABIOMED, between December 2003 and December 2005. The patients were transferred from 40 spokes on the BVS 5000 Blood Pump and converted to the AB5000 Ventricle (both ABIOMED) at hubs. Comparisons were made on implant indications, time-course, and end-organ function at the time of conversion between surviving patients and patients that had died. Patients who were transferred and converted had a survival to recovery or to next therapy rate of 42%. Eighteen of the surviving patients were still alive 30 days after the explant: 61% were weaned, 33% were transplanted, and 5.6% received a destination device. Average implant-to-transfer time was 1.5 vs. 2.0 days for 30-day survivors and expired patients, respectively, whereas support time from transfer to conversion was 4.8 vs. 4 days, respectively. At the time of device conversion, a total bilirubin below a threshold level of 3.5 mg/dL was predictive of 30-day survival (n = 26, p = .03, odds ratio = 2.73, 95% confidence interval: 1.22-6.16). Patients who survived 30 days were supported longer than those who died (35 vs. 21.1 days, p = .026). At least 18 patients recovered sufficiently on the AB5000 Ventricle to tolerate extubation and 11 patients were able to ambulate. Liver function after implant both at the spoke and before conversion at the hub may be a good indicator of patient survivability. Patients transferred from the BVS 5000 Blood Pump benefited from easy, safe conversion to the AB5000 Ventricle, which provided them with additional support time and afforded the opportunity to recover native heart function.
在这项回顾性研究中，对从偏远的“辐条”医院转诊并在三级医疗“枢纽”医院非手术转换为适合行走的装置的心室辅助装置（VAD）患者的植入过程和结果进行了评估。此前尚未对影响转诊和转换装置这一关键决策的因素进行描述。2003年12月至2005年12月期间，美国26家枢纽机构的50例患者的数据被自愿提交至ABIOMED的VAD数据登记处。这些患者从40个“辐条”机构转诊而来，最初使用BVS 5000血泵，在枢纽机构转换为AB5000心室装置（均为ABIOMED产品）。对存活患者和死亡患者在转换时的植入指征、时间进程和终末器官功能进行了比较。转诊并转换装置的患者恢复或接受下一治疗的生存率为42%。18例存活患者在装置移除后30天仍存活：61%成功撤机，33%接受了移植，5.6%接受了长期植入装置。30天存活者和死亡患者从植入到转诊的平均时间分别为1.5天和2.0天，而从转诊到转换的支持时间分别为4.8天和4天。在装置转换时，总胆红素低于3.5mg/dL的阈值可预测30天生存率（n = 26，p = 0.03，比值比 = 2.73，95%置信区间：1.22 - 6.16）。存活30天的患者接受支持的时间比死亡患者更长（35天对21.1天，p = 0.026）。至少18例患者在AB5000心室装置上恢复良好，能够耐受拔管，11例患者能够行走。在“辐条”机构植入后以及在枢纽机构转换前的肝功能可能是患者生存能力的良好指标。从BVS 5000血泵转诊而来的患者受益于轻松、安全地转换为AB5000心室装置，这为他们提供了额外的支持时间，并为恢复自身心脏功能提供了机会。
