Baylor College of Medicine, St. Luke's Episcopal Hospital, Houston, Texas, USA.
J Heart Lung Transplant. 2011 May;30(5):515-22. doi: 10.1016/j.healun.2010.12.009. Epub 2011 Jan 22.
The use of large, pulsatile left ventricular assist devices (LVADs) has been limited in women because of their small body size.
We compared the survival outcomes, quality of life, and adverse events in 465 patients (104 women, 361 men) with advanced systolic heart failure in their first 18 months of support with the HeartMate II (Thoratec Corp, Pleasanton, CA) continuous-flow LVAD for bridge to transplantation.
During the first 18 months, there were no differences in survival between women and men while on LVAD support (73% ± 3% vs 73% ± 5%, p = 0.855) but fewer women (40%) underwent heart transplantation than did men (55%; p = 0.001). More women continued on support after 18 months (p = 0.007). Median duration of support was 238 days for women and 184 days for men (p = 0.003). Mortality was 20% for women and 19% for men (p = 0.89). Adverse events were similar, with the exception of hemorrhagic stroke, which occurred more frequently in women (0.10 vs 0.04 events/patient-year, p = 0.02), and device-related infections, which occurred less frequently in women (0.23 vs 0.44, p = 0.006). Functional capacity and quality of life at 6 months improved significantly in women and men.
Continuous-flow left ventricular assistance as a bridge to transplantation is associated with similar survival rates in women and men. Differences observed in higher stroke rates and fewer infections among women require further study.
由于体型较小，大型、脉动式左心室辅助装置（LVAD）在女性中的应用受到限制。
我们比较了 465 例（104 例女性，361 例男性）接受 HeartMate II（Thoratec Corp，加利福尼亚州普莱森顿）连续血流 LVAD 桥接移植的晚期收缩性心力衰竭患者在最初 18 个月支持期间的生存结果、生活质量和不良事件。
在 LVAD 支持期间，女性和男性的生存率没有差异（73%±3%对 73%±5%，p=0.855），但接受心脏移植的女性（40%）少于男性（55%；p=0.001）。更多的女性在 18 个月后继续接受支持（p=0.007）。女性的中位支持时间为 238 天，男性为 184 天（p=0.003）。女性的死亡率为 20%，男性为 19%（p=0.89）。不良事件相似，除了女性更常发生的出血性中风（0.10 对 0.04 例/患者年，p=0.02）和女性较少发生的与器械相关的感染（0.23 对 0.44，p=0.006）。女性和男性的 6 个月时的功能能力和生活质量均显著改善。
作为桥接移植的连续血流左心室辅助与女性和男性的相似生存率相关。在女性中观察到的更高中风率和更少感染的差异需要进一步研究。
