Garatti Andrea, Bruschi Giuseppe, Colombo Tiziano, Russo Claudio, Lanfranconi Marco, Milazzo Filippo, Frigerio Maria, Vitali Ettore
Department of Cardiovascular Disease E. Malan, Cardiac Surgery Unit, Policlinico S. Donato Hospital, Via Morandi 30, S. Donato Milanese, Milan, Italy.
Eur J Cardiothorac Surg. 2008 Aug;34(2):275-80; discussion 280. doi: 10.1016/j.ejcts.2008.02.019. Epub 2008 Mar 28.
Long-term implantable continuous axial-flow pumps are increasingly used in bridging heart failure patients to heart transplant. Compared to pulsatile left ventricular assist devices (LVADs), they offer smaller dimensions, less surgical trauma and less thromboembolisms. However concerns still remain about the long-term effects of continuous-flow on patients' outcome. The aim of this study was to review our mechanical bridge to transplant experience to compare pre- and post-transplant outcomes between pulsatile and continuous-flow LVAD recipients.
Thirty-six patients with a continuous-flow device (Micromed DeBakey, Houston, TX or InCor Berlin Heart, Berlin, Germany--group A) were compared with 41 patients supported with a pulsatile device (Novacor, WorldHeart, Oakland, CA--group B).
Mean age (48.6+/-12.4 vs 47.2+/-12.5) and LVAD duration (119.3+/-115.4 vs 128.3+/-198.3) were similar in the two groups. Group A recipients were smaller compared to group B (mean body surface area=1.77+/-0.18 vs 1.93+/-0.16; p<0.001). Idiopathic dilated cardiomyopathy was not significantly greater between the two groups (78% vs 58.3%; p=0.085). Successful bridging to transplantation was similar in group A compared to group B (52.8% vs 63.4%; p=non significant). On-VAD mortality was similar between the two groups (A vs B=33.3% vs 36.6%; p=non significant). Thirty-day mortality after HTx in group A was 10.5% compared to 7.7% in group B (p=non significant). First year post-transplant incidence of treated rejections (36.8% vs 46%; p=non significant) as the mean number of rejection/patient (0.38+/-0.5 vs 0.53+/-0.83; p=non significant) were similar in group A compared to group B.
In our experience, when compared to pulsatile LVAD, continuous-flow pumps are similarly effective in transplant rate and post-transplant outcome.
长期可植入式连续轴流泵越来越多地用于将心力衰竭患者过渡到心脏移植。与搏动性左心室辅助装置（LVAD）相比，它们尺寸更小、手术创伤更小且血栓栓塞更少。然而，对于连续血流对患者预后的长期影响仍存在担忧。本研究的目的是回顾我们的机械过渡到移植的经验，以比较搏动性和连续血流LVAD接受者移植前后的预后。
将36例使用连续血流装置的患者（Micromed DeBakey，休斯顿，德克萨斯州或InCor Berlin Heart，柏林，德国 - A组）与41例使用搏动性装置支持的患者（Novacor，WorldHeart，奥克兰，加利福尼亚州 - B组）进行比较。
两组的平均年龄（48.6±12.4对47.2±12.5）和LVAD使用时间（119.3±115.4对128.3±198.3）相似。A组接受者比B组更小（平均体表面积 = 1.77±0.18对1.93±0.16；p<0.001）。两组间特发性扩张型心肌病的比例无显著差异（78%对58.3%；p = 0.085）。A组与B组成功过渡到移植的比例相似（52.8%对63.4%；p = 无显著差异）。两组的VAD期间死亡率相似（A组对B组 = 33.3%对36.6%；p = 无显著差异）。A组心脏移植后30天死亡率为10.5%，B组为7.7%（p = 无显著差异）。A组与B组相比，移植后第一年治疗排斥反应的发生率（36.8%对46%；p = 无显著差异）以及平均每位患者的排斥反应次数（0.38±0.5对0.53±0.83；p = 无显著差异）相似。
根据我们的经验，与搏动性LVAD相比，连续血流泵在移植率和移植后预后方面同样有效。
