From the *Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY; and †Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY.
ASAIO J. 2013 Nov-Dec;59(6):564-9. doi: 10.1097/MAT.0b013e3182a816d1.
Data on how the timing of a temporary right ventricular assist device (RVAD) insertion affects outcome are limited in patients receiving left ventricular assist device (LVAD). Of the 282 patients who underwent LVAD placement between January 2000 and November 2010, 40 (14%) required concomitant (n = 26) or delayed (n = 14) RVAD insertion as temporary support. We analyzed early and 1-year outcomes. Preoperative variables were similar in the concomitant and delayed RVAD groups. The hospital mortality rate was approximately 50% in both groups (p = 0.82). The 1-year actuarial survival was similar in both groups (p = 0.42). Patients who required RVAD support had higher in-hospital mortality and worse 1-year survival rates than those who received LVAD only (48% vs. 9.5%, p < 0.0001; 40% vs. 82%, p < 0.0001). Multivariate logistic regression analysis indicated RVAD use as a significant risk factor for 1-year mortality (odds ratio, 18; p = 0.0003; 95% confidence interval, 3.765-86.74). Timing of temporary RVAD insertion did not affect overall survival. Necessity of RVAD support is associated with significantly worse early and late mortality at any rate. The decision to place the RVAD can be made once it is clinically necessary.
在接受左心室辅助装置 (LVAD) 治疗的患者中，关于临时右心室辅助装置 (RVAD) 插入时机如何影响结果的数据有限。在 2000 年 1 月至 2010 年 11 月期间接受 LVAD 植入的 282 名患者中，有 40 名（14%）需要同时（n=26）或延迟（n=14）插入 RVAD 作为临时支持。我们分析了早期和 1 年的结果。同时 RVAD 组和延迟 RVAD 组的术前变量相似。两组的住院死亡率均约为 50%（p=0.82）。两组的 1 年生存率相似（p=0.42）。需要 RVAD 支持的患者的住院死亡率和 1 年生存率均低于仅接受 LVAD 治疗的患者（48% vs. 9.5%，p<0.0001；40% vs. 82%，p<0.0001）。多变量逻辑回归分析表明，RVAD 使用是 1 年死亡率的显著危险因素（优势比，18；p=0.0003；95%置信区间，3.765-86.74）。RVAD 插入时机并不影响总体生存率。RVAD 支持的必要性与任何情况下的早期和晚期死亡率显著增加相关。一旦临床需要，就可以决定放置 RVAD。
