Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Eur J Heart Fail. 2013 Oct;15(10):1185-93. doi: 10.1093/eurjhf/hft127. Epub 2013 Jul 30.
Heart transplantation (HTx) is limited by the scarcity of suitable donor hearts. Consequently, more patients with advanced heart failure require a ventricular assist device (VAD). We report U.K. activity, trends, and outcome for long-term VAD support as a bridging therapy to HTx.
Patients were grouped into three eras: E1, February 2004-March 2006; E2, April 2006-March 2009; and E3, April 2009-March 2011. Exclusions were patients who received isolated short-term support or extracorporeal membrane oxygenation without prior or subsequent long-term VAD support. A total of 247 patients received VAD support; 202 left ventricular (LVAD) support alone and 45 both left and right ventricular support. Activity increased over time, from 36 patients implanted in E1 to 123 in E3. Overall, 46 patients received a first-generation device, 80 a second-generation device, and 121 a third-generation device. Use of third-generation devices increased from <6% in E1 to 78% in E3. Median duration of LVAD support increased from 141 days in E1 to 578 days in E3 (P < 0.001). Overall survival to 1 year after LVAD implant rose from 58.3% [95% confidence interval (CI) 40.7-72.4%] in E1 to 72.5% (95% CI 63.3-79.8%) in E3 (P = 0.21), and improved significantly with device generation; at 1 year, 50% of patients with first-generation devices were alive compared with 68.1% and 76.9% of patients with second- and third-generation devices, respectively (P = 0.002). These differences remained after risk adjustment. HTx following LVAD implant reduced over time (P < 0.001).
VAD activity and duration of support have increased. There has been a shift from first- and second- to third-generation devices, and an associated improvement in survival.
心脏移植（HTx）受到合适供体心脏稀缺的限制。因此，更多晚期心力衰竭患者需要心室辅助装置（VAD）。我们报告了英国长期 VAD 支持作为 HTx 桥接治疗的活动、趋势和结果。
患者分为三个时期：E1 期，2004 年 2 月至 2006 年 3 月；E2 期，2006 年 4 月至 2009 年 3 月；E3 期，2009 年 4 月至 2011 年 3 月。排除了仅接受短期支持或体外膜氧合治疗而无先前或随后长期 VAD 支持的患者。共有 247 例患者接受 VAD 支持；202 例单独接受左心室（LVAD）支持，45 例同时接受左心室和右心室支持。随着时间的推移，活动量增加，E1 期有 36 例患者植入，E3 期有 123 例患者植入。总体而言，46 例患者使用第一代设备，80 例患者使用第二代设备，121 例患者使用第三代设备。第三代设备的使用率从 E1 期的<6%增加到 E3 期的 78%。LVAD 支持的中位持续时间从 E1 期的 141 天增加到 E3 期的 578 天（P<0.001）。LVAD 植入后 1 年的总体生存率从 E1 期的 58.3%[95%置信区间（CI）40.7-72.4%]上升到 E3 期的 72.5%（95%CI 63.3-79.8%）（P=0.21），并且随着设备代际的改善而显著提高；在 1 年时，第一代设备的 50%患者存活，而第二代和第三代设备的 68.1%和 76.9%患者存活（P=0.002）。这些差异在风险调整后仍然存在。LVAD 植入后 HTx 的比例随着时间的推移而减少（P<0.001）。
VAD 活动和支持时间都有所增加。已经从第一代和第二代设备转向第三代设备，并且生存率也有所提高。
