Department of Cardiology, Erasmus Medical Center, Thoraxcenter, 3015 CE Rotterdam, the Netherlands.
Eur Heart J. 2009 Sep;30(17):2102-8. doi: 10.1093/eurheartj/ehp292. Epub 2009 Jul 18.
Studies have compared safety and efficacy of percutaneous left ventricular assist devices (LVADs) with intra-aortic balloon pump (IABP) counterpulsation in patients with cardiogenic shock. We performed a meta-analysis of controlled trials to evaluate potential benefits of percutaneous LVAD on haemodynamics and 30-day survival.
Two independent investigators searched Medline, Embase, and Cochrane Central Register of Controlled Trials for all controlled trials using percutaneous LVAD in patients with cardiogenic shock, where after data were extracted using standardized forms. Weighted mean differences (MDs) were calculated for cardiac index (CI), mean arterial pressure (MAP), and pulmonary capillary wedge pressure (PCWP). Relative risks (RRs) were calculated for 30-day mortality, leg ischaemia, bleeding, and sepsis. In main analysis, trials were combined using inverse-variance random effects approach. Two trials evaluated the TandemHeart and a recent trial used the Impella device. After device implantation, percutaneous LVAD patients had higher CI (MD 0.35 L/min/m(2), 95% CI 0.09-0.61), higher MAP (MD 12.8 mmHg, 95% CI 3.6-22.0), and lower PCWP (MD -5.3 mm Hg, 95% CI -9.4 to -1.2) compared with IABP patients. Similar 30-day mortality (RR 1.06, 95% CI 0.68-1.66) was observed using percutaneous LVAD compared with IABP. No significant difference was observed in incidence of leg ischaemia (RR 2.59, 95% CI 0.75-8.97) in percutaneous LVAD patients compared with IABP patients. Bleeding (RR 2.35, 95% CI 1.40-3.93) was significantly more observed in TandemHeart patients compared with patients treated with IABP.
Although percutaneous LVAD provides superior haemodynamic support in patients with cardiogenic shock compared with IABP, the use of these more powerful devices did not improve early survival. These results do not yet support percutaneous LVAD as first-choice approach in the mechanical management of cardiogenic shock.
已有研究比较了经皮左心室辅助装置（LVAD）与主动脉内球囊反搏（IABP）在心源性休克患者中的安全性和疗效。我们对对照试验进行了荟萃分析，以评估经皮 LVAD 对血流动力学和 30 天生存率的潜在益处。
两位独立的研究者在 Medline、Embase 和 Cochrane 对照试验中心注册数据库中检索了所有使用经皮 LVAD 治疗心源性休克患者的对照试验，然后使用标准化表格提取数据。使用加权均数差（MD）计算心指数（CI）、平均动脉压（MAP）和肺毛细血管楔压（PCWP）。计算 30 天死亡率、腿部缺血、出血和败血症的相对风险（RR）。在主要分析中，使用逆方差随机效应方法合并试验。两项试验评估了 TandemHeart，最近一项试验使用了 Impella 装置。在植入装置后，与 IABP 组相比，经皮 LVAD 组患者的 CI 更高（MD0.35L/min/m2，95%CI0.09-0.61）、MAP 更高（MD12.8mmHg，95%CI3.6-22.0）、PCWP 更低（MD-5.3mmHg，95%CI-9.4 至-1.2）。与 IABP 相比，经皮 LVAD 患者的 30 天死亡率相似（RR1.06，95%CI0.68-1.66）。与 IABP 组相比，经皮 LVAD 组患者腿部缺血的发生率（RR2.59，95%CI0.75-8.97）无显著差异。与 IABP 相比，TandemHeart 患者的出血（RR2.35，95%CI1.40-3.93）明显更多。
虽然与 IABP 相比，经皮 LVAD 在心源性休克患者中提供了更好的血流动力学支持，但这些更强大的装置的使用并不能改善早期生存率。这些结果尚未支持经皮 LVAD 作为心源性休克机械治疗的首选方法。
