Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
Ann Thorac Surg. 2013 Mar;95(3):870-5. doi: 10.1016/j.athoracsur.2012.10.080. Epub 2012 Dec 4.
Although current left ventricular assist device (LVAD) technology has proven more durable than first-generation devices, all mechanical devices are prone to complications that can elevate patient acuity before transplantation. LVAD patients with complications intuitively carry a higher risk profile than other status 1A LVAD patients who are generally stable and use their 30 days of clinically stable status 1A time. We sought to determine if the presence or absence of complications in status 1A LVAD patients at the time of transplant influenced survival after transplant.
The United Network of Organ Sharing database was retrospectively analyzed for 15,253 patients who were listed status 1A from 1998 to 2008. Survival after transplant survival was compared between patients who were and were not listed for LVAD-related complications. Standard statistical analysis was applied.
No survival difference was identified at 1 and 10 years after transplant in patients who had device complications compared with those without complications. Of the five complication entries (thromboembolism, infection, malfunction, malignant arrhythmia, and other), only device infection increased mortality risk compared with noncomplicated patients (39% at 1 year, 30% at 10 years, p < 0.01).
Long-term outcomes are generally not affected by the status 1A listing criteria for patients bridged to transplant with LVADs. However, the subset of patients with device infection had worse 1-year and 10-year posttransplant survival. Bridge to transplant patients, despite serious device-related complications, still have excellent transplant outcomes.
尽管目前的左心室辅助装置 (LVAD) 技术比第一代设备更耐用，但所有机械装置都容易发生并发症，这些并发症在移植前会使患者病情恶化。与一般稳定且使用 30 天临床稳定 1A 状态的其他 1A 状态 LVAD 患者相比，具有并发症的 LVAD 患者直观地具有更高的风险状况。我们试图确定在移植时处于 1A 状态的 LVAD 患者是否存在并发症会影响移植后的生存。
回顾性分析了 1998 年至 2008 年期间在 15253 名患者中列出的 1A 状态的美国器官共享网络数据库。比较了移植后具有和不具有 LVAD 相关并发症的患者的移植后生存情况。应用标准统计分析。
与无并发症患者相比，在移植后 1 年和 10 年，具有设备并发症的患者没有生存差异。在五个并发症条目（血栓栓塞、感染、故障、恶性心律失常和其他）中，只有设备感染与非复杂患者相比增加了死亡率风险（1 年时为 39%，10 年时为 30%，p<0.01）。
对于用 LVAD 桥接移植的患者，长期结果通常不受列入 1A 状态的标准影响。然而，具有设备感染的患者亚组在移植后 1 年和 10 年的生存率较差。尽管存在严重的设备相关并发症，桥接移植患者仍有极好的移植结果。
