Pal Jay D, Piacentino Valentino, Cuevas Angela D, Depp Tim, Daneshmand Mani A, Hernandez Adrian F, Felker G Michael, Lodge Andrew J, Rogers Joseph G, Milano Carmelo A
Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27705, USA.
Ann Thorac Surg. 2009 Nov;88(5):1457-61; discussion 1461. doi: 10.1016/j.athoracsur.2009.07.021.
Bridge to heart transplantation with a left ventricular assist device (LVAD) can be a promising therapy for patients who are not effectively stabilized with conservative measures. However, referral for LVAD therapy may be limited secondary to reports of poor outcomes when mechanical circulatory support is required before transplantation.
A retrospective review was undertaken to evaluate outcomes in United Network of Organ Sharing (UNOS) status 1 heart transplant recipients who were bridged to transplant with an implantable LVAD or with intravenous inotropes only from 1994 to 2007. Preoperative characteristics, posttransplant survival, and postoperative complications were compared between 86 patients with an implantable LVAD and 173 patients bridged with intravenous inotropes only.
The patients had similar baseline characteristics and pretransplant hemodynamics. Hemodynamics in the LVAD group, as measured by cardiac index, pulmonary vascular resistance, central venous pressure, and pulmonary capillary wedge pressure, significantly improved during mechanical support. Short-term and long-term posttransplant survival and the incidence of posttransplant infectious complications and rejection episodes during the first year was similar. The incidence of posttransplant renal dysfunction was higher in patients bridged with inotropes.
Patients bridged to transplant with a LVAD represent a subset of UNOS status 1 patients who deteriorated on intravenous inotropic therapy. Bridging to heart transplantation with an implantable LVAD provides comparable outcomes to similar status 1 patients who were stabilized on inotropic infusions only. In contrast with International Society of Heart and Lung Transplantation data, no increase in posttransplant morbidity or mortality occurred in LVAD-bridged patients.
对于经保守治疗未能有效稳定病情的患者，使用左心室辅助装置（LVAD）过渡到心脏移植可能是一种有前景的治疗方法。然而，由于有报道称在移植前需要机械循环支持时预后较差，LVAD治疗的转诊可能会受到限制。
进行一项回顾性研究，以评估1994年至2007年期间通过植入式LVAD或仅通过静脉注射强心剂过渡到移植的器官共享联合网络（UNOS）1级心脏移植受者的预后。比较了86例植入式LVAD患者和173例仅通过静脉注射强心剂过渡的患者的术前特征、移植后生存率和术后并发症。
患者具有相似的基线特征和移植前血流动力学。通过心脏指数、肺血管阻力、中心静脉压和肺毛细血管楔压测量，LVAD组在机械支持期间的血流动力学显著改善。移植后的短期和长期生存率以及第一年移植后感染并发症和排斥反应的发生率相似。仅通过强心剂过渡的患者移植后肾功能不全的发生率更高。
通过LVAD过渡到移植的患者代表了UNOS 1级患者中的一个亚组，这些患者在静脉注射强心剂治疗时病情恶化。使用植入式LVAD过渡到心脏移植与仅通过强心剂输注稳定病情的类似1级患者相比，预后相当。与国际心肺移植学会的数据相反，LVAD过渡患者移植后的发病率或死亡率没有增加。
