作为移植桥梁的连续流左心室辅助装置植入后的年龄与预后
Age and outcome after continuous-flow left ventricular assist device implantation as bridge to transplantation.
作者信息
Sandner Sigrid E, Zimpfer Daniel, Zrunek Philipp, Rajek Angela, Schima Heinrich, Dunkler Daniela, Zuckermann Andreas O, Wieselthaler Georg M
机构信息
Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria.
出版信息
J Heart Lung Transplant. 2009 Apr;28(4):367-72. doi: 10.1016/j.healun.2009.01.008.
OBJECTIVE
The effect of age on outcomes after continuous-flow left ventricular assist device (LVAD) implantation as a bridge to transplantation (BTT) was determined.
METHODS
From November 1998 to July 2007, 86 patients with advanced heart failure underwent continuous-flow LVAD implantation as BTT and were retrospectively analyzed. Patients were categorized into 2 groups by age at LVAD implantation: 56 patients (65.1%) younger than 60, Group 1; and 30 (34.9%) aged 60 years or older, Group 2.
RESULTS
Group 2 patients had a higher incidence of heart failure caused by ischemic heart disease (63.3% vs 32.1%, p = 0.005) and more severely impaired renal function by Modification of Diet in Renal Disease-derived glomerular filtration rates (51.9 +/- 15.9 vs. 68.0 +/- 20.5 ml/min/1.73 m(2), p < 0.001) than Group 1. Age was the only independent predictor of post-LVAD death (hazard ratio, 1.4 p = 0.003). The BTT rate was lower (33.3% vs 62.5%, p = 0.010), and incidence of post-LVAD renal failure was higher (53.3% vs 30.4%, p = 0.037) in Group 2 vs Group 1. Post-LVAD survival at 1, 3, and 6 months was 92.9%, 79.9%, and 74.0% for Group 1 and 90.0%, 62.0%, and 37.0% for Group 2 (p = 0.007). Post-transplant survival at 1, 3, and 5 years was 87.8%, 82.3%, and 76.0% for Group 1 and 90.0%, 67.5%, 67.5% for Group 2 (p = 0.517).
CONCLUSIONS
Patients aged 60 years and older have inferior post-LVAD survival; however, post-transplant survival is excellent. We advocate LVAD placement as bridge-to-transplant therapy only in carefully selected older patients most well suited for transplantation.
目的
确定年龄对作为移植桥梁（BTT）的连续流左心室辅助装置（LVAD）植入术后结局的影响。
方法
1998年11月至2007年7月，86例晚期心力衰竭患者接受了作为BTT的连续流LVAD植入，并进行回顾性分析。根据LVAD植入时的年龄将患者分为两组：56例（65.1%）年龄小于60岁为第1组；30例（34.9%）年龄60岁及以上为第2组。
结果
第2组患者缺血性心脏病导致心力衰竭的发生率较高（63.3%对32.1%，p = 0.005），且根据肾脏病膳食改良法得出的肾小球滤过率显示肾功能损害更严重（51.9±15.9对68.0±20.5 ml/min/1.73 m²，p < 0.001）。年龄是LVAD植入术后死亡的唯一独立预测因素（风险比，1.4，p = 0.003）。第2组的BTT率较低（33.3%对62.5%，p = 0.010），LVAD植入术后肾衰竭的发生率较高（53.3%对30.4%，p = 0.037）。第1组LVAD植入术后1、3和6个月的生存率分别为92.9%、79.9%和74.0%，第2组分别为90.0%、62.0%和37.0%（p = 0.007）。第1组移植后1、3和5年的生存率分别为87.8%、82.3%和76.0%，第2组分别为90.0%、67.5%、67.5%（p = 0.517）。
结论
60岁及以上患者LVAD植入术后生存率较差；然而，移植后生存率良好。我们主张仅在经过精心挑选且最适合移植的老年患者中进行LVAD作为移植桥梁的治疗。
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