Department of Medicine, David Geffen School of Medicine, University of California-Los Angeles, CA, USA.
J Heart Lung Transplant. 2012 Aug;31(8):831-8. doi: 10.1016/j.healun.2012.04.010.
Prior studies have identified risk factors for survival in patients with end-stage heart failure (HF) requiring left ventricular assist device (LVAD) support. However, patients with biventricular HF may represent a unique cohort.
We retrospectively evaluated a consecutive cohort of 113 adult, end-stage HF patients at University of California Los Angeles Medical Center who required BIVAD support between 2000 and 2009.
Survival to transplant was 66.4%, with 1-year actuarial survival of 62.8%. All patients were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1 or 2 and received Thoratec (Pleasanton, CA) paracorporeal BIVAD as a bridge to transplant. Univariate analyses showed dialysis use, ventilator use, extracorporal membrane oxygenation use, low cardiac output, preserved LV ejection fraction (restrictive physiology), normal-to-high sodium, low platelet count, low total cholesterol, low high-density and high-density lipoprotein, low albumin, and elevated aspartate aminotransferase were associated with increased risk of death. We generated a scoring system for survival to transplant. Our final model, with age, sex, dialysis, cholesterol, ventilator, and albumin, gave a C-statistic of 0.870. A simplified system preserved a C-statistic of 0.844. Patients were divided into high-risk or highest-risk groups (median respective survival, 367 and 17 days), with strong discrimination between groups for death.
We have generated a scoring system that offers high prognostic ability for patients requiring BIVAD support and hope that it may assist in clinical decision making. Further studies are needed to prospectively validate our scoring system.
先前的研究已经确定了需要左心室辅助装置 (LVAD) 支持的终末期心力衰竭 (HF) 患者的生存风险因素。然而，双心室 HF 患者可能代表一个独特的队列。
我们回顾性评估了加利福尼亚大学洛杉矶医疗中心的 113 名连续成年终末期 HF 患者，他们在 2000 年至 2009 年期间需要 BIVAD 支持。
移植存活率为 66.4%，1 年实际存活率为 62.8%。所有患者均为机构间机械辅助循环支持登记处 (INTERMACS) 级别 1 或 2，接受 Thoratec（加利福尼亚州普莱森顿）体外 BIVAD 作为移植桥接。单变量分析显示透析、呼吸机、体外膜氧合、低心输出量、保留左心室射血分数（限制性生理学）、正常至高钠、血小板计数低、总胆固醇低、高密度脂蛋白和高密度脂蛋白低、低白蛋白和天门冬氨酸转氨酶升高与死亡风险增加相关。我们生成了一个移植存活评分系统。我们的最终模型，包括年龄、性别、透析、胆固醇、呼吸机和白蛋白，给出了 0.870 的 C 统计量。简化系统保留了 0.844 的 C 统计量。患者分为高风险或最高风险组（中位数分别为 367 天和 17 天），两组之间的死亡率存在很强的差异。
我们已经生成了一个评分系统，为需要 BIVAD 支持的患者提供了高度的预后能力，希望它可以帮助临床决策。需要进一步的前瞻性研究来验证我们的评分系统。
