Department Cardiovascular Surgery, Sharp Memorial Hospital, San Diego, California, USA.
ASAIO J. 2009 Nov-Dec;55(6):598-601. doi: 10.1097/MAT.0b013e3181bd446a.
The duration times of left ventricular assist system (LVAS) support have increased because of prolonged wait times for transplant and the more frequent use of devices for destination therapy. The HeartMate LVAS, the only device approved for bridge to transplant and destination therapy, has limited durability, making replacement increasingly necessary. Since 1996, we have exchanged 19 left ventricular assist devices in 15 patients (11 men: mean age, 57.1 years; range, 33-77 years). Most of the devices (14) were replaced with the HeartMate vented electric/extended-lead vented electric pump; five devices were exchanged for a HeartMate II LVAS. Bearing failure was the most frequent reason for exchange (15 of 19 pumps); four of the 19 pumps also had active device-related infections at the time of exchange. There were no early deaths (30 days). Overall survival (Kaplan-Meier) was 85% at 1 year, 67% at 2 years, and 56% at 3 years. Three patients had transplants (mean, 518 days); six patients died during support (mean, 934 days), and six patients remain on LVAS support (mean, 1,219 days). One patient has been on device for over 6 years. Left ventricular assist devices exchange is becoming increasingly likely and can be associated with acceptably low-operative mortality rates and good intermediate-term survival.
由于等待移植的时间延长以及更频繁地使用目的地治疗设备，左心室辅助系统 (LVAS) 的支持时间已经延长。HeartMate LVAS 是唯一获准用于桥接移植和目的地治疗的设备，其耐用性有限，因此越来越需要更换。自 1996 年以来，我们已经在 15 名患者（11 名男性：平均年龄 57.1 岁；范围 33-77 岁）中交换了 19 个左心室辅助装置。大多数设备（14 个）都被 HeartMate 通风电动/延长导电线通风电动泵取代；5 个设备被 HeartMate II LVAS 取代。轴承故障是最常见的更换原因（19 个泵中的 15 个）；在更换时，19 个泵中有 4 个还存在活动性设备相关感染。无早期死亡（30 天）。总体生存率（Kaplan-Meier）为 1 年时为 85%，2 年时为 67%，3 年时为 56%。3 名患者接受了移植（平均 518 天）；6 名患者在支持期间死亡（平均 934 天），6 名患者仍在接受 LVAS 支持（平均 1219 天）。1 名患者已使用设备超过 6 年。左心室辅助装置的更换越来越常见，并且可以与可接受的低手术死亡率和良好的中期生存率相关。
